In the late 1960’s, Dr. Nils Koch of Gotteborg, Sweden created the first Continent Ileostomy in an attempt to provide a better life style for patients whose large intestines had to be removed for treatment of colitis and other diseases.
In the past, patients requiring Proctocolectomy for ulcerative colitis needed an ileostomy to deal with intestinal waste. Patients with ileostomies needed to wear an appliance or “bag” to collect the waste. As an alternative, Dr. Koch constructed a internal reservoir by refashioning the small intestine. A one way valve, also made from the small intestine, was added to the reservoir to prevent the flow of waste to the outside until a small tube was inserted by the patient to overcome the valve.
The Koch Pouch was hailed as a major advance by patients and their physicians who realized that regaining control over intestinal function provided a much better life than the conventional ileostomy. However, the popularity of the Koch Pouch decreased when surgeons found that its construction was technically demanding and was sometimes associated with complications. The continued search for operations that preserved continence led to the development of the Restorative Proctocolectomy (J-Pouch) as the operation of choice for patients with Ulcerative Colitis.
Dr. Launer studied with Dr. Koch in Sweden and both Drs. Launer and Worsey had extensive experience with the Koch Pouch at the Cleveland Clinic. Between them they have performed more than 350 Koch Pouches.
The Koch Pouch remains an excellent alternative to the Restorative Proctocolectomy in patients over age 50, in patients with incontinence, and in patients who have not had good results from prior J-Pouch operations.