Kock pouch as an attractive option for patients whose only alternative is conventional ileostomy

Patients with failures of ileal pouch anal anastomosis (IPAA) are often offered a conventional ileostomy. A less well known but attractive alternative is the establishment of Kock pouch, a continent ileostomy. To date conversion of failed IPAA to Kock pouch has been performed at only a few centers in Sweden, Norway, Germany, and in the USA.
Although complications associated with Koch pouch may not be inferior to those of IPAA or conventional ileostomy, patient satisfaction is around 90% and the majority of patients report high quality of life (QoL), as assessed by validated QoL rating tools.
At our hospital 65 patients have so far received Kock pouch. Thirteen of these patients received Kock pouch due to failed IPAA. The current rate of Kock surgery is one to three patients per year. Among the 65 patients, five Kock pouches were excised, and about 50% of the patients were submitted to revisional surgery one or several times, mostly due to nipple valve slippage.
With the decrease in number of patients operated with Kock pouch important pre- and postoperative routines may to some extent have been forgotten. The successful implementation of Kock pouch relies on several important factors, including thorough preoperative information/discussion with surgeons and nurses, detailed postoperative procedures, and careful postoperative as well as longterm follow-up. The contribution of the stoma nurse in this setting is essential.
Kock pouch is an attractive option for selected patients with failed IPAA, ulcerative colitis and familial adenomatous polyposis (FAP). Stoma nurses schould be aware of this option and the professional skills required for successful implementation. Important issues related to Kock pouch care and experience from our practice will be presented.