Kock Pouch Frequently Asked Questions

Click here for the Ileostomy FAQ.

1. I have a Kock pouch. Occasionally I have had some difficulties with it, can a BCIR surgeon help me with my Kock pouch?

Yes, a BCIR is a modification of the Kock pouch. A BCIR surgeon will know what to look for when treating your medical problems or difficulties and will respect the pouch. A surgeon who is not experienced with continent ileostomies may quickly suggest taking down the Kock pouch and creating a Brooke ileostomy.

2. I have a Brooke ileostomy and am considering switching to a BCIR. But, I live in Kansas. There is no BCIR surgeon nearby, what do you recommend? How will I get follow-up care?

Many of my patients fly to Los Angeles from throughout the U.S. for their care. Individuals should expect to spend at least two weeks for surgery and recuperation. Follow-up care will be by means of regularly scheduled telephone appointments and in concert with your regular physicians as needed. I am available to speak with local doctors any time. If a problem develops with the pouch, a patient would have to return to me in Los Angeles.

3. I have had to go to the Emergency Room for my Kock pouch. What should I say to the examining doctor so that he understands what it is?

Most general surgeons are familiar with the important work of Dr. Nils Kock in creating the continent reservoir, however, occasionally you might see an E.R. doctor who is unfamiliar with the pouch. I have two important recommendations for you to keep in a convenient place to take with you to an emergency room. You might want to keep these in the container with your catheter: 1) the name and phone number of a BCIR/Kock pouch surgeon, preferably one you have spoken to and who is familiar with you, and 2) a schematic drawing of the Kock pouch which you can find in the patient handbook.

The BCIR/Kock pouch surgeon should be able to discuss the pouch with the E.R. doctor on the phone and suggest a course of treatment.

4. I have been having some difficulties with my Kock pouch and would like to switch to a BCIR. Is that possible?

A BCIR is a modification of the Kock pouch so the usual procedure would include revision of the Kock pouch to the Barnett type. Occasionally a different revision is needed, or only a stoma revision, without going internally. A pouch endoscopy and sometimes a pouchogram XRay will determine the nature of the problem, and the extent of revision needed to correct the difficulty. A Kock pouch or Barnett pouch endoscopy is like intubating (draining the pouch), plus blowing air in through the scope to see the pouch better. This type of endoscopy does not require any anesthesia or sedation, or even starting an IV.

5. I have a BCIR and am concerned that when I travel, if I need medical attention, the emergency room physician or other local doctor will not understand what a BCIR is. What do you suggest?

The name "BCIR" is not familiar to many E.R. doctors. I recommend that all BCIR patients refer to their procedure as a modification of the Kock pouch. I also suggest that you keep the following information in the container you keep your catheter or somewhere convenient: 1) the name and phone number of a BCIR/Kock pouch surgeon, preferably one you have spoken to and who is familiar with you, and 2) a schematic drawing of the Kock pouch which you can find in the patient handbook.

The BCIR/Kock pouch surgeon should be able to discuss the pouch with the E.R. doctor on the phone and suggest a course of treatment.

6. What is the difference between a Kock Pouch and the BCIR pouch?

The BCIR or Barnett modification of the Kock Pouch continent intestinal reservoir ileostomy, differs in 3 fundamental ways from the traditional Kock pouch technique. First, the BCIR has a single longitudinal suture line, not the triangulated design. Second, the nipple valve is isoperistaltic in the direction of the pouch. Finally, the intestinal collar that wraps around the outside of the valve segment is designed to reduce the possibility of a slipped valve.