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Appendicostomy stomas and antegrade colonic irrigation after laparoscopic antegrade continence enema
Jeff Kim1, Spencer W Beasley, Kiki Maoate
1Department of Paediatric Surgery, Christchurch Hospital, Christchurch, New Zealand.
Insights
Laparoscopic antegrade continence enema (LACE) is effective for bowel management but often causes stomal issues like stenosis and infection. Younger children and those with anorectal malformations face more complications and challenges with LACE.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Urology
Background:
- Children with spina bifida, anorectal anomalies, or neuronal intestinal dysplasia often require fecal management.
- Laparoscopic antegrade continence enema (LACE) is a surgical technique to improve fecal continence.
- Stoma-related complications can impact the effectiveness of LACE.
Purpose of the Study:
- To identify the types and frequency of LACE-related stoma and catheterization problems.
- To investigate the relationship between these problems and the underlying pediatric condition.
Main Methods:
- Retrospective review of medical records.
- Analysis of 74 consecutive patients who underwent LACE.
Main Results:
- LACE is generally well-tolerated but associated with complications like stomal stenosis, leakage, and infection.
- 19% of patients required stoma revision, primarily for stenosis and skin overgrowth.
- Anorectal malformations were linked to difficulties in colonic emptying.
Conclusions:
- LACE is an effective bowel emptying method but has a high rate of minor, troublesome complications.
- Stomal stenosis and skin overgrowth are the most frequent issues.
- Younger children experience more complications, and anorectal malformation patients may need additional bowel management interventions.
Background:
Children with spina bifida, high anorectal anomalies, or neuronal intestinal dysplasia who are treated with a laparoscopic antegrade continence enema to achieve a socially acceptable level of fecal continence sometimes have problems with the stoma and its catheterization. The goal of this study was to determine the nature and incidence of these problems, and their relationship to the underlying condition.
Materials And Methods:
A retrospective review of the hospital case notes of 74 consecutive patients who had a laparoscopic antegrade continence enema was undertaken.
Results:
The laparoscopic antegrade continence enema procedure is well tolerated but is associated with a variety of usually minor complications including stomal stenosis, leakage, peristomal infection, granulation tissue overgrowth, mucosal prolapse, abdominal discomfort during irrigation, appendiceal false passage, and ineffective irrigation. Surgical revision of the stoma was required in 19% of the cases in this study, usually because of stenosis and skin overgrowth. Ongoing problems achieving colonic emptying were most likely to occur in patients with an anorectal malformation.
Conclusion:
Overall, the laparoscopic antegrade continence enema provides an effective method of facilitating emptying of the bowel. However, it has a high incidence of minor troublesome problems, with stenosis and skin overgrowth of the stoma being the most common. Younger children tend to have more complications and difficulty performing effective irrigation. Children with anorectal malformations were more likely to require surgical revision of the stoma, and often needed ongoing manual evacuation and bowel washouts despite the laparoscopic antegrade continence enema.
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