CPT® Code 44316

A continent ileostomy, commonly known as the Kock procedure, is a surgical intervention designed for patients who have undergone a coloproctectomy, which is the removal of the colon and rectum. This procedure creates an internal pouch that serves as a reservoir for stool, allowing for the collection of fecal matter without the need for external stoma bags or devices. The procedure involves making a midline incision in the abdomen to access the ileum, which is the final section of the small intestine. A specific segment of the ileum, typically between 45 to 60 centimeters, is mobilized and folded back on itself. This segment is then opened and sutured together to form a pouch, which can be shaped like an 'S' or 'J'. The distal segment of the ileum, approximately 15 centimeters long, is utilized to create an ileal valve, which is essential for controlling the flow of stool from the reservoir. To facilitate this, electrocautery is employed to scarify the 15-centimeter segment of ileum located just distal to the newly formed reservoir. The adjacent mesentery, which is the tissue that attaches the intestines to the abdominal wall, is excised to allow for proper positioning of the bowel. The scarified segment is then telescoped into the reservoir, a process known as intussusception, which helps to form the ileal valve. This telescoped portion is secured to the pouch using staples or sutures, and the pouch is subsequently closed with sutures. Additionally, a separate incision is made, typically in the right lower quadrant of the abdomen, through which the distal end of the ileum is brought to the surface and sutured flush with the skin, creating a stoma. The ileal pouch is then attached to the abdominal wall, and a large diameter plastic tube is inserted into the stoma. This tube remains in place for several weeks and is occluded for progressively longer periods to promote the expansion of the pouch. Once the patient is able to tolerate occlusion for up to eight hours, the tube is removed. Following this, the patient is instructed to intubate the pouch through the ileal stoma several times a day to facilitate the drainage of fecal matter from the reservoir.