The Kock Pouch is an example of a continent ileostomy, so called because the contents of the small intestine stay within the body until the patient decides to empty it. The Kock pouch consists of a reservoir constructed from the small intestine, and a nipple valve which keeps the contents of the reservoir inside the body, and permits entry of an external catheter to drain the pouch when desired.
The catheter is a simple hollow plastic tube. It is inserted about 5 inches into the stoma, and the contents of the reservoir come out on their own. Immediately after surgery the pouch is emptied about every three hours, because the reservoir is small. But following the surgery it grows in size until it can be emptied only 3 or 4 times a day, approximately 2 months after surgery. In the absence of late night meals, it is rare to have to get up at night to empty. This is in contrast to some of the alternative surgeries such as the J pouch, where night time emptyings are generally necessary. In between emptyings, the stoma is covered with a piece of gauze to absorb the mucus coming from it. The stoma is typically about 1/2 inch in diameter.
Total Proctocolectomy with Koch Pouch
This operation involves complete removal of the colon and rectum with the creation of a continent ileostomy. It is similar to that of the Brooke ileostomy, but here a pouch is created inside the abdominal wall with a continent ileostomy. This operation is rarely performed, but can be considered in selected cases in which transanal reconstruction is not a good option.
|Figure 14. Technique for total proctocolectomy with Koch pouch (front and side view)|