Conversion of Barnett continent reservoir to Kock reservoir: A 30-year retrospective study on surgical outcomes and long-term follow-up
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND: The Barnett continent reservoir has long been used as a surgical option for patients requiring continent ileostomies, but complications such as valve leakage, obstruction, and pouch failure often necessitate revisions. Conversion to a Kock (K) pouch offers an alternative with potentially improved outcomes. This study evaluated the safety (postoperative complications), feasibility (technical completion of conversion), and effectiveness (long-term pouch salvage) of conversion. METHODS: We conducted a retrospective cohort study of patients who underwent Barnett-to-K-pouch conversion (conversion group) or remained with a Barnett pouch (non-conversion group) between 1991 and April 2024. The conversion technique included disconnection of the afferent limb, preservation and 180° rotation of the reservoir, resection of the collar valve, creation of a stapled nipple valve, and pouch-neo-afferent limb anastomosis. Demographics, surgical history, and long-term follow-up were collected. Pouch salvage was defined as retention of a functional continent pouch; failure was defined as excision with permanent ileostomy. RESULTS: in conversion versus non-conversion groups, respectively. Ulcerative colitis was the primary indication (62.6% versus 78.8%). Leading revision causes were valve slippage (50% versus 35.7%) and fistula (18.7% versus 28.6%). Pouch salvage was higher with conversion (81.3%, 95% confidence interval [CI] 54-96%) versus non-conversion (35.7%, 95% CI 13-65%; p = 0.03). Long-term follow-up (median: 159.5 versus 301.6 months,) showed that 60% of all patients in conversion group retained continent pouches, while the remaining experienced pouch excision, indicating an overall failure rate of 40%. CONCLUSIONS: Conversion of Barnett to K-pouch improves pouch salvage and reduces failure. While technically complex, the procedure can be safely offered to motivated patients seeking to avoid permanent ileostomy.
Source: Techniques in Coloproctology
Institution: Cleveland Clinic
Language: English
Topic: Stoma care and complications
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,390
OpenAlex ID: W7141042562