Y-appendicoplasty: a technique to minimize stomal complications in antegrade continence enema

The antegrade continence enema (ACE) is an effective method of treatment of fecal incontinence and constipation. However, the original procedure described is not easy to perform and is associated with a high complication rate, especially stomal stenosis-necrosis (55%). Even with introduction of orthotopic appendicostomy, composite series still report an incidence of 30% with stomal problems. The authors report a virtually complication-free simple modification, the Y-appendicoplasty.

The base of the appendix is imbricated into cecum by 2 successive rows of interrupted seromuscular stitches. A small Y-shaped incision is made on the abdominal wall at McBurney's point, and 3 triangular skin flaps are raised. The appendix is brought out of the skin incision. The tip is excised, and 3 vertical cuts are made 120 degrees apart. The 3 appendiceal flaps thus created are interdigitated with the skin flaps using interrupted sutures.

Twelve children underwent Y-appendicoplasty and orthotopic appendicostomy. Mean operating time was 1 hour. None experienced stomal complications that required intervention. Control of fecal continence with ACE ranged from excellent to good.

Y-appendicoplasty and orthotopic appendicostomy minimizes complications for ACE and is easy to perform.