The Kock pouch (continent ileostomy)

The Kock pouch (KP) or continent ileostomy (CI), a groundbreaking ileostomy technique with a reservoir, was introduced in 1969 by Nils Kock. This innovation aimed to enhance the quality of life of patients undergoing proctocolectomy with an end ileostomy, marking a significant stride forward before the advent of restorative surgery. The KP’s initial popularity, however, was inversely proportional to the surgical expertise available, and its application across various conditions, including Crohn’s disease and familial adenomatous polyposis (FAP), led to high complication rates by the late 1970s. These complications often involved valve slippage and high rates of valve and pouch excision. Following the introduction of ileoanal pouch anastomosis (IPAA) by Parks and Nicholls in the 1980s, use of the KP declined. However, with the advent of modern surgical technologies, notably advanced staplers, the KP has evolved significantly. The S‑shaped KP, characterized by its improved postoperative results and facilitating easier endoscopic evaluations, represents this technological evolution. This article details the step-by-step procedure for creating the S‑shaped KP, underscoring its advantages in surgical practice. Recently, the KP has regained significance in light of the high long-term failure rates of IPAA. For younger patients with a terminal ileostomy, the KP is recognized as a viable option for improving quality of life. Its indications extend to both primary and salvage procedures for patients unsuitable for IPAA or those with failed pelvic pouches. Preoperative considerations such as obesity, which complicates the construction and management of the reservoir, and strategic selection of the ostomy outlet site for patient comfort are integral to the process.