Modified technique of antegrade continence enema using a stapling device

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.