Permanent ileostomy without external appliance: Kock internal reservoir (pouch) operation.

Employing a surgical technique described by Dr. Nils Kock of Göteborg, Sweden one can create a continent ileostomy beyond an internal reservoir of ileum for patients who have had total proctocolectomy. This operation is designed to obviate the necessity for wearing an external appliance. Instead, the patient introduces a catheter through the ileostomy into the reservoir of ileum three or four times daily and evacuates it in a convenient manner. Our experience with seven patients, as well as a useful opertive variation of our own, is described. In six patients the procedure was carried out at the time of proctocolectomy. Currently six of the seven patients function without an appliance. Two of the seven had serious postoperative complications which were associated with the pouch. While a number of physical and emotional advantages are ascribed to the procedure, the specific hazards of the complex surgery, the extra time consumed daily in emptying the reservoir, and the necessity for further surgery if the pouch fails to function in a satisfactory manner must be balanced against them. Over the short term, the experience of our patients with this operation has been favorable. Larger series have been reported by Dr. Kock and by Dr. Beahrs at the Mayo Clinic. While 80% of their patients have had satisfactory eventual outcomes, a larger number of secondary operations and an ultimate 20% incidence of unsatisfactory results dictate the necessity for a guarded approach to this procedure.