The Kock Pouch, or K-pouch, is a continent ileostomy procedure that was first performed in 1969 by Dr. Nils Kock, a Professor of Surgery who taught and practiced at the University of Gothenburg in Sweden. It's an option for some patients when their large intestine and rectum need to be removed due to disease or injury. If the anal sphincter muscles are too weak for a J-pouch procedure, the K-pouch could be an alternative to an end ileostomy where a patient eliminates waste (stool) using an ostomy pouching system.
During a K-pouch procedure, an internal reservoir is formed using the terminal ileum after colectomy. The end of the small intestine is then connected to the surface of the abdomen by making a permanent opening (stoma). When waste accumulates in the reservoir, it is emptied several times per day by inserting a catheter into the stoma. Immediately following surgery, an indwelling catheter in the pouch is used to provide constant drainage and left in place for about a month while the K-pouch "matures." After the indwelling catheter is removed, you’ll need to start emptying the pouch several times per day as instructed by your surgeon.
The emptying process isn't difficult, but it might take some patients several weeks to become comfortable with the task. How often you should empty the reservoir depends on your unique body, diet, and activity level.
Here are some guidelines for draining the Kock Pouch:
- Empty the pouch every two hours during the day.
- Empty just before going to bed and again when you awake.
- Refrain from eating or drinking within two hours of bedtime.
When inserting the catheter into the stoma, try the following:
- Relax your abdominal muscles.
- Only use water-soluble lubricants and never use products with petroleum jelly, such as Vaseline.
- If having difficulty, change positions and try again.
Some may need to keep a catheter inserted overnight to provide constant drainage. Within three months after surgery, patients should be able to empty the pouch between 4-6 times a day. Empyting is advised when feeling bloated, a distended stomach, and prior to physical activity.
The K-pouch has its benefits, however, one main problem is maintaining the valve in the proper position. If a patient develops a slipped valve (loss of continence), there will be difficulty inserting the drainage catheter as well as incontinence (waste and/or gas escaping from the stoma). For this reason, some doctors don't recommend a Koch Pouch to their patients. Several specialized surgeons have continued to work hard to improve the original techniques of Dr. Kock in order to reduce the incidence of valve slippage.
Dr. William O. Barnett, a surgeon and gastroenterologist, spent many years modifying the K-pouch to reduce the incidence of a slipped valve. In his version, the Barnett Continent Intestinal Reservoir (BCIR), as the pouch fills the collar also fills creating a noose-like effect, resisting the tendency of the valve slipping out of position. Like the Koch Pouch, the BCIR procedure requires no external ostomy appliance and it can be drained when convenient.
Patients with a K-pouch who require a revision can have their pouch transformed into a BCIR to help reduce the likeliness of recurrent valve slippage. When surgery is required to correct a malfunctioning Kock Pouch, usually the pouch itself is preserved, saving valuable intestinal tissue. There is a high success rate with these revisions and allows patients to maintain a continent pouch instead of having a traditional end ileostomy.