The Kock continent ileostomy.

Over a four and one-half year period, we have performed 100 Kock continent ileostomies with one nonpouch-related mortality. The large majority of these operations have been conversions of existing conventional ileostomies. Modifications in the surgical technique have gradually lowered the complication rate, and postoperative revisions are now required less frequently than for conventional ileostomies. Slippage of the nipple valve, the most troublesome complication of the Kock pouch operation, is currently seen in 4.1 per cent of the patients. Eversions of the nipple valve have been eliminated, and fistulas are now seen rarely. The so-called pouchitis, a postoperative complication noted in 10 per cent of the patients, is usually well controlled with metronidazole. Kock pouches performed upon patients in whom the original diagnosis was Crohn's ileocolitis have been followed by a high incidence of postoperative fistulas, but patients with Crohn's colitis have thus far fared as well as patients with ulcerative colitis. The over-all success rate for the Kock pouch operation in this series of patients is 97 per cent.