The continent ileostomy (Kock pouch)

Introduction: Continent ileostomy describes a stoma with a reservoir (pouch) and complete gas and stool continence, which is achieved via intussusception of a small bowel segment. This procedure was first described by Nils Kock in 1969. Today, the best achievable quality of life and improved functional outcome have gained relevance over the pure survival of former days. In this sense, the Kock pouch—which had been neglected in recent years—is experiencing a revival. Aim: The Kock reservoir procedure was mainly performed in Sweden in the 1970s. In Germany, the experience was centered around K.‑W. Ecker, who modified the original procedure, to improve the most relevant complication of valve slippage (dislocation). Materials and methods: A systematic review of the literature was performed using the most relevant keywords. The literature is was summarized in terms of history, technical aspects, indications, complications, and quality of life. Establishment of the procedure as well as the author’s own experiences are presented. Discussion: The ileoanal pouch was introduced after the Kock pouch and rapidly became the preferred method of reconstruction after proctocolectomy. In approximately 30% of cases, the ileoanal pouch fails and must be removed. The continent Kock pouch offers decisive advantages over Brooke ileostomy due to complete continence and bowel control. Despite high revision rates, the Kock pouch leads to high quality of life and patient satisfaction. In order to serve news demands and allow for universally available patient care, structured education of surgeons and stomal therapists is required. © 2018, Springer Medizin Verlag GmbH, ein Teil von Springer Nature.