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Appendiceal versus ileal segment for antegrade continence enema
Leslie D Tackett1, Eugene Minevich, John F Benedict
1Children's Hospital Medical Center, Cincinnati, OH, USA.
Insights
Continent cecostomy using the appendix or ileum is effective for severe fecal incontinence in children. Both techniques achieve high continence rates with similar complication profiles, offering a successful management option.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Urology
Background:
- Severe bowel dysfunction in children often leads to chronic constipation and fecal incontinence.
- The antegrade continence enema (ACE) procedure aims to improve bowel management.
- Continent cecostomy provides a catheterizable stoma for antegrade enemas.
Purpose of the Study:
- To evaluate the outcomes of continent cecostomy for antegrade continence enema (ACE) in children.
- To compare the use of the appendix versus an ileal segment for creating a continent cecostomy.
- To assess continence rates and complication profiles associated with these techniques.
Main Methods:
- Retrospective review of 45 children with severe chronic constipation and fecal incontinence.
- Continent cecostomy created using either the appendix (28 patients) or an ileal segment (17 patients).
- Simultaneous construction of appendiceal Mitrofanoff neourethra in 16 patients.
Main Results:
- Acceptable continence achieved in 87% and total continence in 69% of patients.
- No significant difference in continence rates between appendix and ileal groups.
- Complications requiring reoperation occurred in 10 patients, primarily stomal stenosis (8 patients).
Conclusions:
- Continent cecostomy is a successful management option for debilitating fecal incontinence in children.
- Both appendix and ileal segments are viable for continent cecostomy creation with comparable outcomes.
- The procedure may facilitate undiversion of existing colostomies.
Purpose:
To assess outcomes after the antegrade continence enema procedure, we present our results with an ileal segment or the appendix in children with severe bowel dysfunction.
Materials And Methods:
A retrospective review of 45 children who had undergone the creation of a continent cecostomy for severe chronic constipation and fecal incontinence was performed.
Results:
The appendix was used to create the continent cecostomy in 28 patients (group 1) and ileum 17 (group 2). Of 16 patients who underwent simultaneous construction of appendiceal Mitrofanoff neourethra, including continent catheterizable stoma, the appendix was split and used for the cecostomy and neourethra in 11. Overall, acceptable continence was achieved in 39 (87%) patients and total continence 31 (69%). No significant difference was noted in the rate of continence between groups 1 and 2. Nonstomal postoperative complications occurred in 5 patients in group 1 and 3 group 2. Complications that required reoperation related to the continent cecostomy occurred in 10 patients, including stomal stenosis in 8, with 6 group 1 and 2 group 2 (p >0.05), and stricture in 2, with 1 group 1 and 1 group 2. There were 2 patients who had previously undergone colostomy for intractable constipation who were undiverted at the time of the creation of continent cecostomy. Both were continent postoperatively. There were 3 patients, including those 2 who presented with chronic severe constipation of unclear etiology, who underwent colostomy for unrecoverable colonic dys-motility, of whom 1 subsequently required total colectomy.
Conclusions:
The creation of a continent cecostomy for antegrade continence enema is a successful management option in children with debilitating fecal incontinence, and may enable undiversion of an existing colostomy. The appendix and ileal segment are viable options for the procedure, with no significant difference noted in continence or complication rates.