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Laparoscopic-Assisted Percutaneous Endoscopic Cecostomy (LAPEC) in Children and Young Adults
Shifra Koyfman1,2, Kristen Swartz2, Allan M Goldstein2,3
1Division of Pediatric Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Insights
The laparoscopic-assisted percutaneous endoscopic cecostomy (LAPEC) procedure is safe and effective for treating refractory constipation and fecal incontinence in pediatric and young adult patients. This minimally invasive approach offers a high success rate with few complications.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Minimally Invasive Procedures
Background:
- Refractory constipation and fecal incontinence significantly impact quality of life in children and young adults.
- Medical management and antegrade continence enema (ACE) regimens are often insufficient for severe cases.
- Surgical intervention may be necessary when conservative treatments fail.
Purpose of the Study:
- To evaluate the safety and efficacy of the laparoscopic-assisted percutaneous endoscopic cecostomy (LAPEC) procedure.
- To assess outcomes in pediatric and young adult populations.
- To review pre-operative factors and post-operative complications.
Main Methods:
- Retrospective review of 38 patients (32 children, 6 young adults) who underwent LAPEC.
- Evaluation of success defined as daily stool evacuation with minimal incontinence.
- Analysis of pre-operative motility profiles, ACE regimens, and post-operative complications.
Main Results:
- Overall success rate of 95% (36/38 patients).
- Two failures in children attributed to behavioral issues.
- Slightly higher leakage rates in adults (83%) compared to pediatric patients (19%, P=0.003).
- No other significant complications reported.
Conclusions:
- LAPEC is a safe and effective treatment for refractory constipation and fecal incontinence in pediatric and young adult patients.
- The procedure demonstrates a high success rate with minimal complications.
- LAPEC offers a valuable option for patients who have failed conservative medical management.
Objective:
We evaluated the safety and efficacy of the laparoscopic-assisted percutaneous endoscopic cecostomy (LAPEC) procedure both in children and young adults, along with review of their pre-operative motility profiles, antegrade continence enema (ACE) regimen, and postoperative complications.
Methods:
This retrospective review investigated 38 patients (32 children and 6 young adults) that underwent the LAPEC procedure. Primary outcomes evaluated were success versus failure of the procedure and post-operative complications. Success was defined as daily stool evacuation with minimal to no fecal incontinence per week.
Results:
Mean follow up time was 25.8 ± 22.4 months. Indications for LAPEC included slow transit constipation or colonic neuropathy (n = 22), other types of constipation (n = 5), and a variety of congenital disorders (n = 11). The overall success rate was 95% (36/38 patients) with the two failures in children, both attributed to inability to use the tube due to underlying behavioral disorders or severe anxiety. Five patients above age 18 had leakage compared to 6 in the under age 18 group (83% vs. 19, P = 0.003). There were no other significant complications.
Conclusion:
LAPEC is a safe and effective means of addressing refractory constipation and fecal incontinence in children and young adults who have failed medical management with minimal post-operative complications.
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