Delayed kock pouch nipple valve failure: Is revision indicated?

PURPOSE: This study was designed to review our experience with patients who, after more than 10 years of normal Kock pouch valve function, required repair of the valve. In addition, we describe the surgical techniques employed for valve repair. METHODS: A retrospective chart review identified 31 patients who underwent Kock pouch revision after a minimum time interval between previous pouch surgery and the current revision of 10 (average, 19.7) years. RESULTS: The intraoperative findings included slipped valve, valve prolapse, and internal nipple valve fistulas. The procedures performed included standard valve reconstruction, turnaround procedures, pedicle repair, wall stapling, and oversewing of fistula. Twelve of the 31 patients failed the initial revision and required additional operations, with an overall pouch salvage success rate of 93 percent. Only two patients required excision of the pouch and conversion to a Brooke ileostomy. The procedures were performed with minimal morbidity and no mortality. CONCLUSION: Surgical revision can be offered to patients with a continent ileostomy complicated by delayed valve dysfunction with low morbidity and good functional outcome.