Continent ileostomy: current status

Abstract

Continent ileostomy (Kock pouch) is an alternative to end ileostomy for patients who have undergone total proctocolectomy. The procedure reached its height of popularity in the late 1960s and early 1970s, but has been supplanted by restorative proctocolectomy, 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 restorative proctocolectomy, for whom restorative proctocolectomy or end ileostomy have failed, and in a few other selected cases. Complication rates have decreased during the past three decades following technical improvements, but remain significant. In this review, the author summarizes the current indications for continent ileostomy, examines recent technical modifications, and discusses the management of complications.

Keywords: Continent ileostomy; Kock pouch; complications; technique.

Figure 1

The conversion of a J-pouch to a continent ileostomy.

Figure 2

The 3-limb S-pouch continent ileostomy.

Figure 3

The Barnett continent ileal reservoir (BCIR).

Figure 4

Pouch rotation for failed nipple valve.

Figure 5

The T-pouch.