A conventional ileostomy produces faeces without control and is therefore acting
most of the time. For this reason an appliance has to be worn constantly. The
Kock ileostomy aims to produce an ileostomy which is continent until such time
as the person wishes to empty it. Therefore, it is not necessary to wear an
appliance.
Indications
For those patients who have had their anal sphincters removed or have too poor
anal muscle tone to have an ileo-anal pouch, the Kock ileostomy provides an
alternative to a conventional ileostomy.
Technique
The abdomen is opened and the large bowel is removed as for a
proctocolectomy. The last 45cm of small intestine are used to construct the
reservoir. The end piece of the intestine is pulled back into the reservoir to make
a valve. A flush ileostomy is made from the small intestine leading away from the
pouch and the valve. When the pressure in the reservoir builds up as it fills with
faeces, the valve is squeezed shut and faeces cannot escape. A special tube
(catheter) is inserted into the pouch and sometimes secured to the skin with a
stitch before closure of the abdominal wound.
The post-operative period
As soon as the bowels start working again, as shown by the production of flatus
(wind) and, eventually, the appearance of faeces from the catheter, the patient
may start drinking and eating. Once bowel activity returns, the faeces drains out
of the pouch, through the catheter that was inserted during the operation. The
catheter remains in the pouch for four to six weeks from the operation to allow
the valve to heal.
To ease the management of this it is recommended that an ileostomy appliance
is initially worn to collect the faeces. Prior to discharge from hospital the Stoma
Care Nurse will teach on how to manage the practical
aspects of Kock pouch care including cleaning and changing the ileostomy
appliance and irrigation of the pouch (see below). This is necessary as the
catheter may block with faeces and it is important that the faeces are able to flow
freely so as not to put the pouch under any pressure. Patients can usually leave
hospital after two weeks and will therefore need to manage the catheter at home
for a further two to four weeks.
At home
A low residue diet is advised. Foods that are hard to chew and hard to digest
may not easily pass through the catheter. The hospital dietician will be able to
advise on dietary needs.
At the follow-up out-patient appointment, the catheter is removed, rinsed and
reinserted by the surgeon or Stoma Care Nurse. This enables the surgeon or
nurse to teach how the catheter should be inserted.
When the reservoir is full, the sensation felt by the patient is of an abdominal
fullness. To empty, the person inserts the catheter through the ileostomy into the
reservoir and drains off the contents into the lavatory. This is usually necessary
about three to five times per day.
If the stool is especially thick then irrigation may be necessary to ensure
complete emptying. This is done by inserting the catheter into the reservoir and,
with the aid of a syringe, instil tap water into the reservoir. The process is
continued until the drainage is clear. Some patients wear a small dressing or a
stoma cap over the Kock ileostomy. The Stoma Care Nurse will be able to give
instructions in carrying out this procedure.
Patients with a Kock ileostomy are strongly advised to wear a medialert tag
informing other health care professionals that they have a continent diversion.
Complications
There are some problems with the operation. The most common is slippage of
the valve. If it slides out of the reservoir then the ileostomy ceases to be
continent and faeces leaks out. An appliance is then necessary. To rectify the
situation another operation will be required to replace the valve. This happens in
about 20-30% of cases, but is less frequent as the surgeon’s experience of the
operation increases.
The more recent development of the ileo-anal pouch operation has reduced the
need for the Kock ileostomy, but there are still instances in which it is a suitable
option. These mostly include patients who have had a proctocolectomy with
permanent ileostomy who wish to improve their quality of life. They must
appreciate, however, that the Kock ileostomy may involve further major surgery
without guarantee of success.
most of the time. For this reason an appliance has to be worn constantly. The
Kock ileostomy aims to produce an ileostomy which is continent until such time
as the person wishes to empty it. Therefore, it is not necessary to wear an
appliance.
Indications
For those patients who have had their anal sphincters removed or have too poor
anal muscle tone to have an ileo-anal pouch, the Kock ileostomy provides an
alternative to a conventional ileostomy.
Technique
The abdomen is opened and the large bowel is removed as for a
proctocolectomy. The last 45cm of small intestine are used to construct the
reservoir. The end piece of the intestine is pulled back into the reservoir to make
a valve. A flush ileostomy is made from the small intestine leading away from the
pouch and the valve. When the pressure in the reservoir builds up as it fills with
faeces, the valve is squeezed shut and faeces cannot escape. A special tube
(catheter) is inserted into the pouch and sometimes secured to the skin with a
stitch before closure of the abdominal wound.
The post-operative period
As soon as the bowels start working again, as shown by the production of flatus
(wind) and, eventually, the appearance of faeces from the catheter, the patient
may start drinking and eating. Once bowel activity returns, the faeces drains out
of the pouch, through the catheter that was inserted during the operation. The
catheter remains in the pouch for four to six weeks from the operation to allow
the valve to heal.
is initially worn to collect the faeces. Prior to discharge from hospital the Stoma
Care Nurse will teach on how to manage the practical
aspects of Kock pouch care including cleaning and changing the ileostomy
appliance and irrigation of the pouch (see below). This is necessary as the
catheter may block with faeces and it is important that the faeces are able to flow
freely so as not to put the pouch under any pressure. Patients can usually leave
hospital after two weeks and will therefore need to manage the catheter at home
for a further two to four weeks.
At home
A low residue diet is advised. Foods that are hard to chew and hard to digest
may not easily pass through the catheter. The hospital dietician will be able to
advise on dietary needs.
At the follow-up out-patient appointment, the catheter is removed, rinsed and
reinserted by the surgeon or Stoma Care Nurse. This enables the surgeon or
nurse to teach how the catheter should be inserted.
When the reservoir is full, the sensation felt by the patient is of an abdominal
fullness. To empty, the person inserts the catheter through the ileostomy into the
reservoir and drains off the contents into the lavatory. This is usually necessary
about three to five times per day.
If the stool is especially thick then irrigation may be necessary to ensure
complete emptying. This is done by inserting the catheter into the reservoir and,
with the aid of a syringe, instil tap water into the reservoir. The process is
continued until the drainage is clear. Some patients wear a small dressing or a
stoma cap over the Kock ileostomy. The Stoma Care Nurse will be able to give
instructions in carrying out this procedure.
Patients with a Kock ileostomy are strongly advised to wear a medialert tag
informing other health care professionals that they have a continent diversion.
Complications
There are some problems with the operation. The most common is slippage of
the valve. If it slides out of the reservoir then the ileostomy ceases to be
continent and faeces leaks out. An appliance is then necessary. To rectify the
situation another operation will be required to replace the valve. This happens in
about 20-30% of cases, but is less frequent as the surgeon’s experience of the
operation increases.
The more recent development of the ileo-anal pouch operation has reduced the
need for the Kock ileostomy, but there are still instances in which it is a suitable
option. These mostly include patients who have had a proctocolectomy with
permanent ileostomy who wish to improve their quality of life. They must
appreciate, however, that the Kock ileostomy may involve further major surgery
without guarantee of success.
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