PROBLEMS ENCOUNTERED WITH THE KOCK ILEOSTOMY

A review was made of the problems that occurred in the first 12 patients in our series of Kock reservoir ileostomies. Only four patients had no complications or problems. The reservoir was removed in two patients and a new reservoir constructed in four. Despite these problems, at 1 to 3 years all nine patients still being followed up have continent, well functioning ileostomies. A prosthetic material (Impragraft®) was used to support the valve in seven cases. This worked well, but foreign body fistulas requiring stoma revision developed in two patients. Frequently, superficial mucosal ulceration and an inflammatory histologic reaction were observed in the reservoirs of patients who formerly had ulcerative colitis. These conditions were not observed in patients who had had familial polyposis. One patient with ulcerative colitis had a recurrence of arthritis. Despite these problems, we believe that if one uses good patient selection, some new technical maneuvers in constructing the reservoir, and some of the postoperative devices and practices developed during this experience, the Kock reservoir ileostomy should be constructed in the appropriate cases. © 1979.