Clin Colon Rectal Surg 2004; 17(1): 57-63
DOI: 10.1055/s-2004-823071
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Clinical Aspects of Continent Ileostomies

David E. Beck1
  • 1Department of Colon and Rectal Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana
Further Information

Publication History

Publication Date:
13 April 2004 (online)

Continent ileostomy (Kock pouch) is an alternative to end ileostomy for patients who have undergone total proctocolectomy. The procedure reached the height of its popularity soon after its introduction in 1969, but subsequently was supplanted by ileal pouch-anal anastomosis (IPAA), an operation that preserves the natural route of defecation. Continent ileostomy is still appropriate for selected patients with ulcerative colitis and familial polyposis who are not candidates for IPAA or for whom IPAA or end ileostomy have failed. Complication rates that initially were high have decreased during the past three decades following the steady introduction of technical improvements.

REFERENCES

  • 1 Kock N G. Intra-abdominal “reservoir” in patients with permanent ileostomy: preliminary observations on a procedure resulting in fecal “continence” in five ileostomy patients.  Arch Surg. 1969;  99 223-231
  • 2 Wu J S, Fazio V W. Continent ileostomy: evolution of design.  Clin Colon Rectal Surg. 2002;  15 231-243
  • 3 Beahrs O H. Use of ileal reservoir following proctocolectomy.  Surg Gynecol Obstet. 1975;  141 363-366
  • 4 Goldman S L, Rombeau J L. The continent ileostomy: a collective review.  Dis Colon Rectum. 1978;  21 594-599
  • 5 Schrock T R. Complications of continent ileostomy.  Am J Surg. 1979;  138 162-169
  • 6 Cranley B. The Kock reservoir ileostomy: a review of its development, problems and role in modern surgical practice.  Br J Surg. 1983;  70 94-99
  • 7 Dozois R R, Kelly K A, Ilstrup D et al.. Factors affecting revision rate after continent ileostomy.  Arch Surg. 1981;  116 610-613
  • 8 Fazio V W, Church J M. Complications and function of the continent ileostomy at the Cleveland Clinic.  World J Surg. 1988;  12 148-154
  • 9 Parks A G, Nicholls R J. Proctocolectomy without ileostomy for ulcerative colitis.  BMJ. 1978;  2 85-88
  • 10 Fazio V W, Ziv Y, Church J M et al.. Ileal pouch-anal anastomoses complications and function in 1005 patients.  Ann Surg. 1995;  222 120-127
  • 11 Farouk R, Pemberton J H, Wolff B G et al.. Functional outcomes after ileal pouch-anal anastomosis for chronic ulcerative colitis.  Ann Surg. 2000;  231 919-926
  • 12 Roy P H, Sauer W G, Beahrs O H, Farrow G M. Experience with ileostomies. Evaluation of long-term rehabilitation in 497 patients.  Am J Surg. 1970;  119 77-86
  • 13 Sagar P M, Dozois R R, Wolff B G, Kelly K A. Disconnection, pouch revision and reconnection of the ileal pouch-anal anastomosis.  Br J Surg. 1996;  83 1401-1405
  • 14 Fazio V W, Wu J S, Lavery I C. Repeat ileal pouch-anal anastomosis to salvage septic complications of pelvic pouches: clinical outcome and quality of life assessment.  Ann Surg. 1998;  228 588-597
  • 15 Kusunoki M, Sakanoue Y, Shoji Y et al.. Conversion of malfunctioning J pouch to Kock's pouch. Case report.  Acta Chir Scand. 1990;  156 179-181
  • 16 Behrens D T, Paris M, Luttrell J N. Conversion of failed ileal pouch-anal anastomosis to continent ileostomy.  Dis Colon Rectum. 1999;  42 490-496
  • 17 Cohen Z. Evolution of the Kock continent reservoir ileostomy.  Can J Surg. 1982;  25 509-514
  • 18 Church J M, Fazio V W. The continent ileostomy: indications, techniques for construction, and management of complications.  Semin Colon Rectal Surg. 1991;  2 102-110
  • 19 Kock N G, Myrvold H E, Nilsson L O. Progress report on the continent ileostomy.  World J Surg. 1980;  4 143-148
  • 20 Regimbeau J M, Panis Y, Pocard M et al.. Long-term results of ileal pouch-anal anastomosis for colorectal Crohn's disease.  Dis Colon Rectum. 2001;  44 769-778
  • 21 Beck D E. Intestinal stoma. In: Beck DE Handbook of Colorectal Surgery. 2nd ed. New York, NY; Marcel Dekker 2003: 273-275
  • 22 Cranley B. The Kock reservoir ileostomy: a review of its development problems and role in modern surgical practice.  Br J Surg. 1983;  70 94-99
  • 23 Dozois R R, Kelly K A, Beart R W, Beahrs O H. Improved results with continent ileostomy.  Ann Surg. 1980;  192 319-324
  • 24 Kock N G, Darle N, Hulten L, Kewenter J, Myrvoid H, Philipson B. Ileostomy.  Curr Probl Surg. 1977;  14 1-52
  • 25 McLeod R S, Fazio V W. The continent ileostomy: an acceptable alternative.  J Enterostomal Ther. 1984;  11 140-146
  • 26 Barnett W O. Current experiences with the continent intestinal reservoir.  Surg Gynecol Obstet. 1989;  168 1-5
  • 27 Fazio V W, Tjandra J J. Technique for nipple valve fixation to prevent valve slippage in continent ileostomy.  Dis Colon Rectum. 1992;  35 1177-1179
  • 28 Stein J P, Lieskovsky G, Ginsberg D A et al.. The T pouch: an orthotopic ileal neobladder incorporating a serosal-lined ileal antireflux technique.  J Urol. 1998;  159 1836-1842
  • 29 Kaiser A M, Stein J P, Beart Jr R W. T-pouch: a new valve design for a continent ileostomy.  Dis Colon Rectum. 2002;  45 411-415
  • 30 Gorfine S R, Bauer J J, Gelernt I M. Continent stomas. In: MacKeigan J, Cataldo PA Intestinal Stomas. St. Louis; Quality Medical Publishing 1993: 154-187
  • 31 Vernava A M, Goldberg S M. Is the Kock pouch still a viable option?.  Int J Colorectal Dis. 1988;  3 135-138
  • 32 Lepisto A H, Jarvinen H J. Durability of Kock continent ileostomy.  Dis Colon Rectum. 2003;  46 925-928

David E BeckM.D. 

Department of Colon and Rectal Surgery

Ochsner Clinic Foundation, 1514 Jefferson Hwy.

New Orleans, LA 70121

Email: dbeckmd@aol.com