K-Pouch Surgery: Continent ileostomy preserves continence and quality of life
An ileostomy is a surgically created opening connecting the intestine to the outside of the abdomen. Although some ileostomies are temporary and can be reversed after a patient undergoes surgery or recovery, some people must have permanent ileostomies that require an external appliance, or bag, to continuously collect waste. In such cases, the lifestyle changes associated with a permanent ileostomy significantly impact patients’ quality of life.
At NewYork-Presbyterian/Columbia, Ravi P. Kiran, MBBS, Chief and Program Director of the Division of Colorectal Surgery, performs a procedure known as K-pouch surgery (short for Kock pouch, after the Swedish surgeon who developed the procedure, or continent ileostomy) to preserve continence and maintain quality of life in patients who otherwise would have a permanent ileostomy.
K-pouch surgery entails the creation of an internal pouch from a section of the small intestine. The pouch is connected to the opening in the abdominal wall by a special valve, also fashioned out of a segment of the small intestine, which prevents the escape of liquid waste and gas from the pouch. Waste thus collects in the pouch, remaining in the body until the patient needs to empty it. About four or five times per day, the patient simply inserts a small tube into the valve and allows the waste to drain out. In this way, patients have the advantage of remaining continent without having to wear an external appliance.
According to Dr. Kiran, patients are very happy with this option because the ability to remain continent without a bag is so important to their quality of life. Freedom from an external appliance allows patients to wear better fitting clothes, which enhances body image. Patients with a K-pouch may also be able to participate in swimming and other exertional activities, which may otherwise be restricted due to the encumbrance of an external appliance. Skin problems from the adhesives and wafers required for the stoma appliance, which can be problematic in some patients with a conventional ostomy, are also controlled with the K-pouch procedure. While there is a risk that the surgically created valve can slip and require re-operation, the advantages of the K-pouch are still worth it, patients report.
Eligible patients include those who need to have their sphincter removed due to colitis, or if it is not possible to reconnect the intestine to the anal area after removing a segment of the colon. Patients will not be eligible for the K-pouch if they are at risk for intestinal failure, if they have inadequate bowel (small intestine), or if their body weight is excessive.