Proctocolectomy with the Kock Pouch
The Kock Pouch was developed by Professor Nils Kock in Göteborg, Sweden, in 1969. Professor Kock had been working with a continent urinary pouch in cats for approximately 7 years prior to first doing a continent ileostomy in humans. Initially, and during the early 1970s, multiple authors had reported on the outcome of patients undergoing a Kock pouch procedure. The indications at that time were specifically for patients not wishing to have a conventional ileostomy, as this was one alternative to total proctocolectomy and ileostomy. It provided the patient with a mechanism for continence, and overcame a significant number of psychosocial problems related to a conventional ileostomy. However, the procedure itself was, and still is, a complex one, with numerous complications. In fact, initially, the revision rate due to leakage from the continent ileostomy was reported in the 50% range. Initially, the outlet valve from the Kock Pouch was brought out obliquely through the rectus muscles in order to provide a mechanism of continence: in the early 1970s the “nipple” valve was introduced for the same purpose. However, there were problems with stabilization and sliding of the valve which required reoperations.
KeywordsUlcerative Colitis Rectus Muscle Stomal Aperture Total Proctocolectomy Afferent Limb
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