Five years of the pediatric Kock pouch

Since 1976, 16 teenagers at the Hospital for Sick Children, Toronto, have had a Kock pouch constructed. This group consists of 10 females and 6 males ranging in age from 13 to 19 yr. These were all elective pouches: 9 were converted from standard ileostomies, 5 were converted along with proctectomy or Hartmann procedure, and 2 had total colectomies along with a Kock pouch. Two of these conversions were for failed Swenson and Soave procedures. The complications directly related to the Kock pouch were stoma stricture, prolapsed nipple valve, long outflow tract, fecal fistula, salt loss, slipped nipple valve, chronic small bowel obstruction, and "pouchitis." These 8 complications required a total of 16 operations to correct (1.4 operations per patient). The 100% follow-up shows all but 3 followed for more than 1 yr. They are all well, continent, happy, and back to a virtually normal life that includes marriage in 3. The Kock pouch should be an elective procedure and must be done only when the total colon has been removed. There must be rigid selection of pediatric patients for this operation and no children younger than teenage should receive this pouch. Moreover, it may even by worthwhile letting such a child have a standard ileostomy for a while until his or her general condition (both physical and mental) is best able to cope with a Kock pouch.