New surgical technique for creation of a continent appendicostomy: Invaginated appendicostomy

The main complications of appendicostomy are stenosis and stomal fecal leakage. Although many authors report that the appendix is naturally continent, it is recommended to perform a plication of the cecum with the appendix to prevent stomal fecal leakage. We present here the creation of a different continent mechanism. Our technique is advantageous when the anatomy, vascularity, or the length of the appendix does not allow for a standard plication procedure.

During 2014-2016 we performed four appendicostomies in patients with anorectal malformations with fecal incontinence that requested an "Antegrade Continent Enema" procedure after a successful bowel management program in the Colorectal Center for Children of Mexico. The average age at surgery was 13years. All patients had anorectal malformations with a poor prognosis for proper control of defecation, with a sacral ratio lower than 0.4. In these patients, we invaginated a 1cm length of the appendix at its base, placing eight circumferential stitches with 5-0 silk. None of the patients experienced leakage when a saline solution was introduced with a catheter into the cecum during the surgical procedure. After an average of 15months of follow-up, none of the patients were experiencing stomal leakage.

The "Invaginated Appendicostomy" is a reproducible and effective continent mechanism to prevent stomal fecal leakage. It appears to be an excellent alternative to cecal plication around the appendix.