The "Conventional" Ileostomy
Medical conditions exist that often can only be cured by removal of the large intestine (colon and rectum). These include Ulcerative Colitis, Familial Polyposis, abnormal functioning of the colon (colonic inertia), and others. When the entire large intestine must be removed, a new way to evacuate waste must be created. The traditional operation involves bringing the end of the small intestine through an opening in the abdominal wall, and suturing it to the skin. This is called a Brooke ileostomy (named after Dr. Brooke) and requires wearing an external appliance over the stoma to collect the waste.
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Medical conditions exist that often can only be cured by removal of the large intestine (colon and rectum). These include Ulcerative Colitis, Familial Polyposis, abnormal functioning of the colon (colonic inertia), and others. When the entire large intestine must be removed, a new way to evacuate waste must be created. The traditional operation involves bringing the end of the small intestine through an opening in the abdominal wall, and suturing it to the skin. This is called a Brooke ileostomy (named after Dr. Brooke) and requires wearing an external appliance over the stoma to collect the waste.
Read more ...
The Burden of Wearing a "Conventional" Ileostomy...
The majority of people who live with
the Brooke ileostomy lead normal
lives and have an excellent quality
of life. However, 11 % will require
another operation because...
Read more ...
The majority of people who live with
the Brooke ileostomy lead normal
lives and have an excellent quality
of life. However, 11 % will require
another operation because...
Read more ...
The Kock Pouch brings in relief from the Burden of a ...
Dr. Nils G. Kock was born in 1924 in
Finland. He did his surgical
residency training in Sweden and remained there for his entire
career as a Surgeon...
Read more ...
Dr. Nils G. Kock was born in 1924 in
Finland. He did his surgical
residency training in Sweden and remained there for his entire
career as a Surgeon...
Read more ...
An Improvement on the Kock Pouch: "Nipple Valve"
The early experience showed that
while 50% of patients were
continent, the other 50% were
not. This lead to Dr. Kock...
Read more ...
The early experience showed that
while 50% of patients were
continent, the other 50% were
not. This lead to Dr. Kock...
Read more ...
| Surgery Options After Total Colon Removal |
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| Taking Back Control with the Freedom Option |
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| The BCIR - Replacing an External Bag with an Internal Pouch |
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| Diet with a Continent Internal Ileostomy |
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| Ileostomy Options |
Other Resources
The Kock Pouch Complication: The Slipped Valve
The major problem with the Kock procedure is maintaining the valve in the proper position. In the early years (1970s and 1980s), the failure rate was 25-40%, defined as loss of continence. If a patient develops a slipped valve, there will be difficulty inserting the drainage catheter as well as incontinence (waste and/or gas escapes from the stoma spontaneously)...
Read more ...
The major problem with the Kock procedure is maintaining the valve in the proper position. In the early years (1970s and 1980s), the failure rate was 25-40%, defined as loss of continence. If a patient develops a slipped valve, there will be difficulty inserting the drainage catheter as well as incontinence (waste and/or gas escapes from the stoma spontaneously)...
Read more ...
A Further Improvement on the Kock Pouch: A Collar on the Nipple Valve, the Barnett Modification
Dr. William O. Barnett created another modification to...
Read more ...
Dr. William O. Barnett created another modification to...
Read more ...
Converting the Kock Pouch into a Barnett type pouch
Patients who have a Kock pouch that requires revision can have the pouch transformed into the Barnett design to help reduce the likelihood of recurrent valve slippage. Usually when surgery is required to correct a malfunctioning Kock pouch, the pouch itself is preserved, saving valuable intestinal tissue. A new valve and stoma can be created and attached to the side of the pouch, and another connection for...
Read more ...
Patients who have a Kock pouch that requires revision can have the pouch transformed into the Barnett design to help reduce the likelihood of recurrent valve slippage. Usually when surgery is required to correct a malfunctioning Kock pouch, the pouch itself is preserved, saving valuable intestinal tissue. A new valve and stoma can be created and attached to the side of the pouch, and another connection for...
Read more ...
Life with the Kock Pouch
Many studies were done by Dr. Kock to assess quality of life and patient satisfaction after total coloproctectomy (removal of colon and rectum) with creation of the Kock continent ileostomy. There was enhanced self image, decreased expense comparing appliances vs. catheters, improved self-esteem, freedom regarding clothing, and less sexual inhibitions or psychological embarrassment that is associated with an external appliance...
Read more ...
Many studies were done by Dr. Kock to assess quality of life and patient satisfaction after total coloproctectomy (removal of colon and rectum) with creation of the Kock continent ileostomy. There was enhanced self image, decreased expense comparing appliances vs. catheters, improved self-esteem, freedom regarding clothing, and less sexual inhibitions or psychological embarrassment that is associated with an external appliance...
Read more ...
Medical conditions exist that often can only be cured by removal of the large intestine (colon and rectum). These include Ulcerative Colitis, Familial Polyposis, abnormal functioning of the colon (colonic inertia), and others. When the entire large intestine must be removed, a new way to evacuate waste must be created. The traditional operation involves bringing the end of the small intestine through an opening in the abdominal wall, and suturing it to the skin. This is called a Brooke ileostomy (named after Dr. Brooke) and requires wearing an external appliance over the stoma to collect the waste. Since the small intestine is a continuous flow system, there is always material flowing from the stomach down the intestine and out into the appliance (bag). The appliance is attached to the skin with special adhesive and must be worn 24 hours a day forever. If the small intestinal waste contacts the skin it causes erosion and ulcerations because it is caustic to the skin. To prevent this, the ileostomy stoma must protrude above the skin for about 1 inch, so the liquid that comes out goes directly into the bag. This is a "conventional" ileostomy.
The Burden of Wearing a "Conventional" Ileostomy Appliance
The majority of people who live with the Brooke ileostomy lead normal lives and have an excellent quality of life. However, 11 % will require another operation because of problems such as stoma hernia, prolapse (too much length of intestine protrudes) or retraction (the stoma recedes inward making it difficult to maintain a seal with the appliance). Also, a significant number of patients will have a malfunctioning ileostomy, related to either physical abnormalities with the stoma or allergies to the adhesives, or psychological difficulties coping with the need for the external appliance. When ileostomy surgery is performed at a young age, the challenges of having an external stoma in terms of dating and sexual intimacy should not be minimized, as well as the impact on self-image. Many people are dissatisfied with the physical and emotional burden of wearing an ileostomy appliance.The Kock Pouch brings in relief from the Burden of a Conventional Ileostomy Appliance: Continent Ileostomy
Dr. Nils G. Kock was born in 1924 in Finland. He did his surgical residency training in Sweden and remained there for his entire career as a Surgeon. Following extensive laboratory and clinical work, he published a landmark article in 1969. This described a surgical method for achieving fecal continence by creating an internal reservoir (pouch). The reservoir is fashioned from the end of the patient's own small intestine, and leads to an opening (stoma) on the lower abdominal wall. Several times a day the patient sits on the toilet and inserts a catheter (tube) via the stoma opening and into the pouch, draining out the waste material. In between draining (also called intubation) only a small bandage is needed over the stoma to absorb mucous that will be produced by the lining of the intestine. No feces of gas escapes from the internal pouch until the next "intubation".An Improvement on the Kock Pouch: "Nipple Valve"
The early experience showed that while 50% of patients were continent, the other 50% were not. This lead to Dr. Kock developing an added feature to the pouch - a so-called "nipple valve". The valve is created from the intestine itself - it is not a foreign object or device of any kind. A segment of intestine attached to the pouch is grasped in the middle, and then telescoped into itself thereby creating a double layer of intestine that protrudes into the pouch = the valve. This is a self-sealing mechanism so that not only does waste and gas not come out of the stoma by itself, it also prevents water going into the pouch such as with bathing, swimming or scuba diving. Since this type of ileostomy is a "continent ileostomy", it is not designed to wear any external appliance. Therefore the stoma is made flush to the skin (unlike a conventional ileostomy), and can be placed much lower on the abdominal wall, usually just above the pubic hair line on the right (or left) side of the midline. Most people empty their pouch 3-5 times daily, and rarely during the night. Any type of clothing can be worn, as there is no "bag bulge" like a conventional ileostomy. Most people with a Kock pouch eat anything they want and have no limitations in activity.The Kock Pouch Complication: The Slipped Valve
The major problem with the Kock procedure is maintaining the valve in the proper position. In the early years (1970s and 1980s), the failure rate was 25-40%, defined as loss of continence. If a patient develops a slipped valve, there will be difficulty inserting the drainage catheter as well as incontinence (waste and/or gas escapes from the stoma spontaneously). This caused many doctors, surgeons and gastroenterologists, to abandon the Kock procedure and to not recommend it to their patients. However, small numbers of dedicated surgeons (both General Surgeons and Colorectal Surgeons) continued to work on improving the original techniques of Dr. Kock, in order to reduce the incidence of the valve slipping. Some modifications relieved the problem but created new problems. This includes wrapping the outer surface of the valve/pouch with mesh. While this was very effective in eliminating the slipped valve problem, the mesh would gradually erode into the pouch causing a fistula with drainage of waste from the pouch out to the skin near the stoma or through the original surgical incision. This was an even more serious problem because infection is part of the fistula process.A Further Improvement on the Kock Pouch: A Collar on the Nipple Valve, the Barnett Modification
Dr. William O. Barnett created another modification to reduce the incidence of slipped valve. This involves an adjacent segment of intestine that encircles the base of the valve as a "collar" mechanism. As the pouch fills, the collar also fills creating a noose-like effect, resisting the tendency of a valve to slip out of position. This has been called the Barnett modification of the Kock Pouch, or the Barnett Continent Intestinal Reservoir (BCIR).
Converting the Kock Pouch into a Barnett type Pouch
Patients who have a Kock pouch that requires revision can have the pouch transformed into the Barnett design to help reduce the likelihood of recurrent valve slippage. Usually when surgery is required to correct a malfunctioning Kock pouch, the pouch itself is preserved, saving valuable intestinal tissue. A new valve and stoma can be created and attached to the side of the pouch, and another connection for the collar wrap is made as well. In that way a Kock pouch becomes a Barnett type pouch. There is a very high success rate with these revisions, allowing patients to maintain their internal continent ileostomy pouch instead of going back to a conventional ileostomy with its external appliance. Many studies were done by Dr. Kock to assess quality of life and patient satisfaction after total coloproctectomy (removal of colon and rectum) with creation of the Kock continent ileostomy. There was enhanced self image, decreased expense comparing appliances vs. catheters, improved self-esteem, freedom regarding clothing, and less sexual inhibitions or psychological embarrassment that is associated with an external appliance. These findings have been confirmed over the years since Dr. Kock's original work. People with a Kock Pouch can expect to live a long and happy life !