The impact of transcutaneous electrical stimulation therapy on appendicostomy operation rates for children with chronic constipation--a single-institution experience
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Yee Ian Yik1, L C Y Leong, John M Hutson
1F Douglas Stephens Surgical Research and Gut Motility Laboratories, Murdoch Children's Research Institute, Melbourne, Australia.
Insights
Transcutaneous electrical stimulation (TES) has reduced appendicostomy formation rates in children with slow-transit constipation (STC). This minimally invasive procedure for chronic constipation is now less common for STC patients since TES introduction.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Technology
Background:
- Appendicostomy for antegrade continence enema is a surgical option for pediatric chronic constipation.
- Transcutaneous electrical stimulation (TES) was introduced in 2006 at the institution to treat slow-transit constipation (STC).
Purpose of the Study:
- To evaluate the impact of TES introduction on appendicostomy formation rates in children with STC.
- To assess changes in appendicostomy rates for STC versus non-STC indications.
Main Methods:
- A retrospective audit of appendicostomy formation rates was conducted for the periods 2001-2005 and 2006-2010.
- Children were classified as STC or non-STC based on nuclear transit scintigraphy and patient records.
Main Results:
- Appendicostomy formation rates for STC children decreased significantly from 5.4/year (2001-2005) to 1.2/year (2006-2010).
- Rates for non-STC children remained relatively stable, decreasing from 4.8/year to 3.2/year.
- The observed reduction in STC appendicostomy rates coincided with the introduction of TES.
Conclusions:
- Appendicostomy formation rates for STC have significantly decreased since the introduction of TES.
- TES has not been applied to non-STC patients during the study period.
- The findings suggest TES is an effective alternative to appendicostomy for STC in children.
Purpose:
Appendicostomy for antegrade continence enema is a minimally invasive surgical intervention that has helped many children with chronic constipation. At our institution, since 2006, transcutaneous electrical stimulation (TES) has been trialed to treat slow-transit constipation (STC) in children. This retrospective audit aimed to determine if TES use affected appendicostomy-formation rates and to monitor changes in practice. We hypothesized that appendicostomy rates have decreased for STC but not for other indications.
Methods:
Appendicostomy-formation rate was determined for the 5 years before and after 2006. Children were identified as STC or non-STC from nuclear transit scintigraphy and patient records.
Results:
Since 1999, 317 children were diagnosed with STC using nuclear transit scintigraphy with 121 during 2001 to 2005 (24.2/year) and 147 during 2006 to 2010 (29.4/year). Seventy-four children had appendicostomy formation. For 2001 to 2005, appendicostomy-formation rates for STC and non-STC children were similar: 5.4 per year (n = 27) and 4.8 per year (n = 24), respectively. For 2006 to 2010, appendicostomy-formation rates were 1.2 per year (n = 6) for STC and 3.2 per year (n = 16) for non-STC (χ(2), P = .04).
Conclusion:
Since 2006, appendicostomy-formation rates have significantly reduced in STC but not in non-STC children at our institute, coinciding with the introduction of TES as an alternative treatment for STC. Transcutaneous electrical stimulation has not been tested on non-STC children in this period.
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