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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.
The Journal of Urology
|January 17, 2002
Summary
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.