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Laparoscopic antegrade continence enema using a two-port technique.
Brice Antao1, Joanne Ng, Julian Roberts
1Paediatric Surgical Unit, Sheffield Children's Hospital, Sheffield, United Kingdom. briceantao@doctors.org.uk
Summary
Laparoscopic antegrade continence enema (ACE) is effective for fecal incontinence in children. A simplified two-port technique using a gastrostomy button offers a safe and straightforward approach.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Gastroenterology
Background:
- Fecal incontinence and intractable constipation significantly impact children's quality of life.
- The antegrade continence enema (ACE) is an established treatment for fecal incontinence.
- Laparoscopic approaches offer potential advantages in ACE procedures.
Purpose of the Study:
- To report the experience with a laparoscopic antegrade continence enema (ACE) procedure.
- To describe a simplified two-port technique for laparoscopic ACE.
- To evaluate the efficacy and safety of this minimally invasive approach.
Main Methods:
- Twelve children with intractable constipation and fecal soiling underwent laparoscopic ACE over three years.
- A two-port technique (one camera, one working port) was utilized in four cases.
- The appendix or cecum was used for the stoma, and a gastrostomy button was employed for anastomosis.
Main Results:
- The laparoscopic ACE procedure was technically easy to perform with no conversions to open surgery.
- Fecal incontinence resolved completely in 9 out of 12 children and partially in 3.
- No stomal stenosis, leakage, or herniation occurred; one case required revision for wound breakdown.
Conclusions:
- Laparoscopic antegrade continence enema (ACE) is a simple and effective surgical option for pediatric fecal incontinence.
- The two-port technique simplifies the procedure, potentially reducing operative time and complexity.
- Utilizing a gastrostomy button may decrease complications associated with ACE stomas.