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Continent appendicostomy in the treatment of fecal incontinence
Insights
The Malone antegrade appendicostomy procedure effectively manages fecal incontinence in children with specific conditions. This surgical approach offers antegrade colonic irrigation, improving quality of life for patients and their families.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Urology
Background:
- Fecal incontinence is a significant challenge for children with anorectal anomalies or spina bifida.
- Traditional retrograde enemas can be distressing for pediatric patients, especially adolescents.
- The Malone procedure offers antegrade colonic irrigation as an alternative management strategy.
Purpose of the Study:
- To evaluate the efficacy and safety of the Malone antegrade appendicostomy for fecal incontinence in pediatric patients.
- To assess patient selection criteria and surgical outcomes.
- To identify potential complications and their management.
Main Methods:
- A retrospective review of 10 patients (aged 5-24) who underwent Malone antegrade appendicostomy between 1996 and 2003.
- Patients with fecal incontinence due to anorectal anomalies (4) or spina bifida (6) were included.
- Continent appendicostomy was created using the cecal appendix or a cecal flap; continent urinary conduits were performed in 3 patients.
Main Results:
- The Malone procedure was effective in controlling fecal incontinence in most patients.
- Follow-up ranged from 1 to 8 years.
- One patient required reoperation for stomal stenosis; another discontinued stoma use for social reasons.
Conclusions:
- Continent appendicostomy is a straightforward and effective surgical option for managing fecal incontinence in select pediatric patients.
- Successful outcomes depend on patient selection (demonstrated efficacy of retrograde enemas) and motivation.
- Stomal stenosis is the most common complication, treatable with reoperation.
Background:
Fecal incontinence is common in children with anorectal anomalies or spina bifida. If it is possible to achieve fecal control, patients are given a large volume of enema once a day. Retrograde enemas are often unpleasant in children, particularly in adolescents. Malone procedure of antegrade appendicostomy achieves antegrade colonic irrigation.
Material And Methods:
From 1996 to 2003 Malone antegrade appendicostomy was performed in 10 patients with fecal incontinence. The patients were aged from 5 to 24 years. In 4 patients fecal incontinence was due to an anorectal anomaly, and in 6 patients spina bifida. Preoperatively, all patients were given a clysma to control fecal incontinence. The patients, who remained clean with regular usage of the clysma for 24 hours or longer, fulfilled the criterion for the formation of continent appendicostomy. In 9 patients the cecal appendix was used to create a stoma, while in another one a lateral tubularized cecal flap was applied. In 3 patients a continent conduit was also done due to urinary incontinence. The follow-up period was from 1 to 8 years. A patient was reoperated due to stenosis of the stomal aperture, while another one has not been using the stoma because of social reasons.
Conclusion:
Continent appendicostomy is a simple surgery, which is effective in the control of fecal incontinence in most children. It is indicated only in patients in whom the rerograde clysma successfully cleans the colon and if patient and parents are motivated to use it. Possible complications, among which stenosis is the most frequent, can be solved with a reoperation.
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