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Sigmoid irrigation tube for the management of chronic evacuation disorders
Michael W L Gauderer1, James M Decou, John T Boyle
1Departments of Pediatric Surgery and Pediatrics, Children's Hospital, Greenville Hospital System, Greenville, SC, USA.
Insights
Sigmoid tube placement offers a new approach for antegrade colonic irrigation in children with chronic evacuation disorders. This method provides prompt, effective bowel evacuation, potentially improving management for left-sided colonic dysfunction.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Minimally Invasive Procedures
Background:
- Antegrade colonic irrigation via appendicostomy or cecostomy is used for chronic evacuation disorders in children.
- Dysfunction often involves the left colon, making right-sided access less ideal.
Purpose of the Study:
- To develop and evaluate a percutaneous endoscopic, laparoscopically controlled sigmoid irrigation tube placement.
- To provide an alternative access for antegrade colonic irrigation targeting the left colon.
Main Methods:
- A sigmoidoscope was advanced into the sigmoid under laparoscopic guidance.
- A percutaneous needle and guide wire facilitated tube placement through the sigmoid wall.
- A PEG-type catheter was secured, creating a skin-level device for irrigation.
Main Results:
- All 4 pediatric patients achieved prompt bowel evacuation in a sitting position.
- The procedure was successfully completed in all participants.
Conclusions:
- Sigmoid tube placement is a viable alternative to traditional cecal access for antegrade irrigation.
- This technique is simple and may offer physiological benefits for managing left-sided colonic dysfunction.
Background/Purpose:
Antegrade colonic irrigation, in which the right colon is accessed via appendicostomy or cecostomy, now is an important adjunct in the management of children with chronic evacuation disorders. However, in most children, the major area of dysfunction is the left rather than the right colon. The authors developed a simple, percutaneous endoscopic, laparoscopically controlled sigmoid irrigation tube placement and evaluated the results in 4 children.
Methods:
A rigid sigmoidoscope is advanced into the upper sigmoid and the loop brought in contact with the abdominal wall under laparoscopic control. A small skin incision is made and a needle pushed across the abdominal and sigmoid walls into the lumen of the sigmoidoscope. A guide wire is advanced through the needle into the scope and retrieved. After the scope is removed, a PEG-type catheter is attached to the guide wire and pulled back, securing the sigmoid loop to the abdominal wall. The tube is subsequently converted to a skin-level device by simply adding an external port valve.
Results:
All 4 patients achieved prompt evacuation in the sitting position.
Conclusions:
Sigmoid tube for antegrade irrigation is an appealing alternative to conventional cecal access. The procedure is simple and may offer physiologic advantages.