Manhattan Colorectal Surgeons
The Kock Pouch (continent ileostomy) was the first alternative to a permanent,
incontinent ileostomy after total proctocolectomy, usually in the setting
of chronic ulcerative colitis and familial adenomatous polyposis. A Kock
Pouch is made from the last portion of the small bowel, the ileum. It
includes the pouch or reservoir and a nipple valve, both fashioned from
the small intestine. There is a flush abdominal wall stoma, usually placed
well below the belt line. A permanently worn appliance or bag is not necessary.
The pouch is emptied by passing a special catheter through the stoma into
the pouch. The waste is directed into the toilet. Once the pouch is emptied
(usually three or four times daily) a small pad is used to cover the stoma.
The surgeons at Manhattan Surgical Associates learned the technique directly
from Dr. Nils Kock and have since continued to improve the procedure.
Dr. Gelernt, one of the founding members of Manhattan Surgical Associates,
first trained with Dr. Kock in the early 1970s in Gothenberg, Sweden.
Then in the late 1970s, Dr. Bauer trained with Dr. Kock in Sweden and
continued to develop several modifications and refinements to the procedure,
which Dr. Bauer has continued to use to today. Drs. Gelernt and Bauer
performed over 550 Kock pouch procedures between 1975 and 1983, representing
one of the largest experiences in the world. Dr. Gorfine learned the technique
from his mentors, Drs. Gelernt and Bauer, during his residency when the
Kock procedure was more commonly performed. Drs. Chessin and Popowich
both have mastered the technique during their colorectal residencies at
the Mount Sinai Medical Center.
The J pouch procedure with ileoanal anastomosis, a second continence preserving
procedure, was described in 1979. By 1983, J pouch surgery had become
established as the surgical procedure of choice for providing fecal continence
in patients requiring total proctocolectomy, lessening the call for the
Kock Pouch procedure. However, there are still indications for performing
this surgery for patients desiring an alternative to a standard ileostomy.
Indications for Kock Pouch include:
- Patients who have had removal of the colon, rectum and anus including the
anal sphincter muscles.
- Patients who have weak anal sphincter muscles in which case a J pouch would
be likely to fail.
- Patients with chronic ulcerative colitis or familial polyposis and cancer
or pre-cancer (dysplasia) in the rectum requiring removal of the colon,
rectum and the anal sphincter muscles.
- Patients who have had J Pouch surgery that has failed or has resulted in
unacceptable functional results due to infection, fistula, pouchitis,
excessive fecal frequency or incontinence due to anal muscle weakness.
There are some patients who had a Kock Pouch performed in the past, did
well for many years, but then developed problems with the pouch. Potential
problems include difficulty catheterizing the pouch or issues of incontinence.
These pouches can often be repaired by fixing the valve of the pouch without
making an entirely new pouch, allowing the patient to avoid a permanent
incontinent stoma. The surgeons at Manhattan Surgical Associates continue
to revise and repair previously created and malfunctioning Kock pouches
in significant numbers every year.
Contact our Manhattan colorectal surgeons with any questions or concerns.