Editorial
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jul 21, 2012; 18(27): 3479-3482
Published online Jul 21, 2012. doi: 10.3748/wjg.v18.i27.3479
Evolution of continent ileostomy
Gurel Nessar, James S Wu
Gurel Nessar, Department of Gastrointestinal Surgery, Yuksek Ihtisas Hospital, Ankara 06100, Turkey
James S Wu, Department of Colorectal Surgery, Digestive Disease Institute, Cleveland, OH 44195, United States
Author contributions: Nessar G wrote the paper, performed a literature search and analyzed data; and Wu JS performed literature search and contributed to writing the paper.
Correspondence to: Gurel Nessar, MD, Associate Professor, Department of Gastrointestinal Surgery, Yuksek Ihtisas Hospital, Ankara 06100, Turkey. gurelnessar@hotmail.com
Telephone: +90-312-3061430 Fax: +90-312-3124120
Received: December 29, 2011
Revised: February 2, 2012
Accepted: February 16, 2012
Published online: July 21, 2012
Abstract

Continent ileostomy can be defined as a surgical procedure that facilitates planned intermittent evacuation of a bowel reservoir through an ileostomy. It was devised by Nils Kock in 1969. Subsequently, continent ileostomy (or Kock pouch) became a viable alternative in the management of patients who had traditionally required an end ileostomy. Kock pouch appeared to provide substantial physical and psychosocial benefits over a conventional ileostomy. The procedure became popular until ileal pouch anal anastomosis (IPAA) was introduced in 1980. Despite its benefits, continent ileostomy had many short term complications including intubation problems, ileus, anastomotic leaks, peritonitis and valve problems. Operative mortalities have also been reported in the literature. Most of these problems have been eliminated with increasing experience; however, valve-related problems remain as an “Achilles’ heel” of the technique. Many modifications have been introduced to prevent this problem. Some patients have had their pouch removed because of complications mainly related to valve dysfunction. Although revision rates can be high, most of the patients who retain their reservoirs are satisfied with regard to their health status and quality of life. Today, this procedure is still appropriate for selected patients for whom pouch surgery is not possible or for patients who have failed IPAA. Both the patient and their physician must be highly motivated to accept the risk of failure and the subsequent need for revisional operations.

Keywords: Continent ileostomy; Kock pouch; Ileal reservoir; Surgical technique