EXPERIENCES WITH THE CONTINENT KOCK-POUCH

First experiences with Kock-pouches (KP) in 34 patients operated on be tween 1987 and 1992 with stapler-stabilization of the nipple-valve are reported. 18 patients (52,9 %) suffered from ulcerative colitis (CU), 7 patients (20,6 %) from familiar adenomatous polyposis (FAP) and 9 p atients (26,5 %) from Crohn's colitis (CC). Each patient was inappropr iate for ileo-anal pouch-procedure (IAP) and desired fecal control. Sp ecial indications for KP were identic with medical contraindications f or IAP in 52,9 %, refusal of IAP in 17,6 % and loss of sphincter in 29 ,4 %. In 25 patients with CU and FAP the rate of specific early compli cations was 24%. In 5 of 6 cases operative correction was successful. The rate of success was 96 %, which could be maintained over time with a rate of 8,3 % of late complications, that had to be corrected. In 9 patients with CC the rate of success was 77,8 % due to two pouch rese ctions in the early postoperative course. It decreased to 66,6 % in th e further course due to another resection later on. In CC, 3 out of 7 patients had repeated reoperations due to inflammatory complications o f the disease not impairing pouch-function. A severe pouchitis was onl y observed in 2/18 patients with CU (11,1 %). Thus, high rates of succ ess in KP-surgery can be achieved for CU and FAP-patients. But it has to be kept in mind, that KP is not in concurrence with IAP, it is also an alternative to Brooke-ileostomy. Patients with CC are less appropr iate, because the necessity for repeated reoperations due to recurrent disease reduces significantly the overall benefit of the patients, ev en if continence is preserved.