Mucosal colonic tube fistula with antireflux wrap for antegrade colonic enema
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Published on: March 24, 2023
Brendon Douglas Bowkett1, E W Kelly
1Department of Paediatric Surgery, Wellington Childrens Hospital, Wellington, New Zealand. b.bowkett@paradise.net.nz
Insights
A novel mucosal colonic tube technique significantly improves fecal continence in children with severe soiling. This minimally invasive approach offers a continent solution, enhancing quality of life and avoiding complications associated with traditional methods.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Colorectal Surgery
Background:
- Antegrade enemas are crucial for fecal continence in children with congenital anomalies or post-surgical issues.
- Existing access methods like appendicostomy, Chait tubes, or caecostomy buttons have limitations, including device failure and need for anesthesia for replacement.
- Full-thickness colonic tubes can lead to significant leakage, necessitating alternative solutions.
Purpose of the Study:
- To evaluate the efficacy and safety of a novel mucosal colonic tube technique with an anti-reflux wrap for achieving fecal continence.
- To assess the impact of this technique on children's quality of life, focusing on soiling, staining, odor, self-esteem, and socialization.
- To determine the technical feasibility, including ease of catheterization and continence of the fistula site.
Main Methods:
- A prospective study involving six children with severe fecal soiling who underwent the mucosal colonic tube construction.
- Outcomes were assessed using a modified Quality of Life score (QOLI), evaluating soiling, staining, odor, self-esteem, and socialization.
- Technical evaluation focused on ease of catheterization and continence of the mucosal fistula, with a median follow-up of 42 months.
Main Results:
- All six patients experienced dramatic improvement in fecal continence, with complete resolution of soiling.
- Quality of Life scores significantly improved from a mean of 4.75 to 18.5 (possible range 0-21).
- All fistula sites were easily catheterized, with no instances of stenosis or fecal leakage reported. Minor granulations at the entry site were treated in two patients.
Conclusions:
- The mucosal colonic tube technique with an anti-reflux wrap is a highly effective and safe method for achieving fecal continence in selected pediatric patients.
- This innovative approach offers a distinct advantage over traditional methods by providing a continent fistula with minimal complications.
- The technique significantly enhances patients' quality of life, addressing physical and psychosocial aspects of fecal incontinence.
Abstract:
Antegrade enemas can provide children with excellent faecal continence in situations where adequate control has been compromised because of underlying congential anomaly or poor surgical outcome in their treatment. The enema is often delivered through an appendicostomy. If the appendix is absent or utilized for another purpose, then placement of a chait tube or caecostomy button can provide access to the colon for the enema. However, these devices may be associated with breakages, accidental removal and leakage and replacement may require another operative procedure under a general anaesthetic. Full thickness colonic tubes can also be constructed at any point along the colon but in the author's experience, they can be associated with significant leakage of both gas and faecal material. The construction of a mucosal colonic tube with anti-reflux wrap is a technique that avoids the above problems and offers a distinctive advantage in selected situations. The technique relies on tabularising mucosa alone to create a continent fistula. Six children with severe soiling underwent the technique. The outcomes were evaluated using a modified quality of life score (QOLI). The score included assessment of soiling, staining, odour, self-esteem and socialization measure. Technical evaluation included analysis of the ease of catheterization and continence of the mucosal fistula site. All six patients had dramatic improvement in their faecal continence with complete resolution of soiling in all six. Follow up median is 42 months and the range is 6-48 months. QOLI scores improved from a total of 4.75 to 18.5. Possible range is 0-21. All the six fistula sites catheterize easily and no stenosis or faecal leakage has occurred. Two patients required treatment of minor granulations at the entry site of the fistula during the early healing phase.
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