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Modified technique of antegrade continence enema using a stapling device.
C A Sheldon1, E Minevich, J Wacksman
1Division of Pediatric Urology, Children's Hospital Medical Center, University of Cincinnati, Ohio, USA.
The Journal of Urology
|January 27, 2000
Summary
A novel stapling technique enhances antegrade continence enema (ACE) conduit construction, proving effective for patients needing longer conduits or a Mitrofanoff stoma. This method simplifies surgery and ensures reliable catheterization and continence.
Area of Science:
- Pediatric Surgery
- Urology
- Gastroenterology
Background:
- Antegrade continence enema (ACE) procedures are vital for managing fecal incontinence.
- Challenges arise with insufficient appendiceal length for ACE conduit creation.
- Concomitant appendiceal Mitrofanoff stoma may be necessary for urinary diversion.
Purpose of the Study:
- To present a stapling technique for constructing an ACE conduit.
- To address limitations of insufficient appendiceal length.
- To facilitate concomitant appendiceal Mitrofanoff stoma creation.
Main Methods:
- Six pediatric patients requiring ACE underwent cecal tubularization with a stapling device.
- The tubularized segment was imbricated with permanent sutures.
- In three cases, the appendix was split to create a Mitrofanoff stoma.
Main Results:
- Follow-up averaged 16.5 months.
- All patients achieved stomal continence.
- Reliable catheterization of the ACE conduit (6 patients) and Mitrofanoff conduit (3 patients) was confirmed.
Conclusions:
- Cecal tubularization with a stapling device is an effective modification for ACE procedures.
- This technique overcomes appendiceal length limitations and simplifies reconstruction.
- It reliably creates a catheterizable stoma with continence and allows for a Mitrofanoff stoma when needed.