[Experiences with the Kock continent ileostomy].
First experiences with Kock-pouches (KP) in 34 patients operated on between 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 patients (26.5%) from Crohn's colitis (CC). Each patient was inappropriate for ileo-anal pouch-procedure (IAP) and desired fecal control. Special indications for KP were identic with medical contraindications for 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 complications 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 resections in the early postoperative course. It decreased to 66.6% in the further course due to another resection later on. In CC, 3 out of 7 patients had repeated reoperations due to inflammatory complications of the disease not impairing pouch-function. A severe pouchitis was only observed in 2/18 patients with CU (11.1%). Thus, high rates of success 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 appropriate, because the necessity for repeated reoperations due to recurrent disease reduces significantly the overall benefit of the patients, even if continence is preserved.
Ecker
K W
KW
Abteilung für Allgemeine Chirurgie, Abdominal- und Gefässchirurgie, Chirurgische Universitätsklinik Homburg/Saar.
Schmid
T
T
Haberer
M
M
Hildebrandt
U
U
Feifel
G
G
D011125:Adenomatous Polyposis Coli / Q000601:surgery*; D000328:Adult; D000368:Aged; D003093:Colitis, Ulcerative / Q000601:surgery*; D003424:Crohn Disease / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D016737:Proctocolectomy, Restorative / Q000379:methods*; D013528:Surgical Staplers; D013536:Suture Techniques
Erfahrungen mit der kontinenten Ileostomie nach Kock.