A ten-year experience with the pediatric Kock pouch.

In 1981, a five-year experience with the pediatric Kock pouch was reported. This series has now increased to 20 patients with an overall experience of 10 years. There were 12 females and eight males ranging in age from 13 to 19 years. These pouches were all elective: 18 were converted from standard ileostomies, (six with proctectomy or Hartmann procedure), and two had a total proctocolectomy. Three of these conversions were for failed Swenson, Soave, and Duhamel procedures. Sixteen children had ulcerative colitis, three Hirschsprung's disease (one with colon atresia and imperforate anus with rectovaginal fistula), and one colonic polyposis (Gardner's syndrome). None had Crohn's disease. The 100% follow-up shows that 19 of the 20 teenagers have been followed for more than 1 year. The most important conclusions from this 10-year review of 20 teenage Kock pouch patients are (1) this continues to be a difficult operation with a significant potential for complications. (2) After 15 months, there is a very small incidence of nipple valve and outflow tract problems, but the possibility of pouchitis remains between 15 months and 5 years. (3) After 5 years, the chances of any kind of a problem with the Kock pouch are minimal. These children are all well, continent, happy, and back to a virtually normal life that includes marriage and pregnancy. The pediatric Kock pouch continues to be a reasonable alternative for the appropriate teenager, when a standard ileostomy is not desired and/or a pelvic pouch is impossible. It must be done by a surgeon with the necessary interest and experience. Long-term follow-up is essential.