Outcomes after appendicostomy and neo-appendicostomy in a single institution

This study explores the outcomes of appendicostomy and neo-appendicostomy for antegrade enema administration in patients that have established a successful bowel management program with retrograde enemas. We aim to assess long-term use of the channel, indications for a semi-permanent device, and post-operative complications.

A retrospective analysis was conducted including all patients who underwent an appendicostomy or neo-appendicostomy from February 2016 - December 2024 at a single institution. Underlying diagnosis, long-term use of the channel, use of semi-permanent device, and post-operative complications were reviewed. A multivariate analysis with backward selection evaluated variables associated with developing post-operative complications. IRB approval was obtained.

A total of 230 patients were identified with the underlying diagnoses of anorectal malformation (43.9%), neurogenic bowel (32.2%), Hirschsprung's disease (10.9%), and idiopathic constipation (13%). Follow-up ranged from 3 months to 9 years. Ten (4.3%) patients were not using antegrade continence enemas at their most recent follow-up due to having a permanent ileostomy (n = 3) or subsequent successful management with laxatives (n = 7). The most common complications were stricture (26%), wound infection (17.4%), leakage of stool (13%), and mucosal prolapse (9.6%). Forty-nine (21.3%) patients had more than one complication. Forty (17.4%) patients required operative revision. Fifty-three (23%) patients elected to have a semi-permanent device and 43 (18.7%) required 1 to manage leakage or stricture. Patients with idiopathic constipation were more likely to experience leakage.

In this series, more than 95% of patients continue to have successful long-term use of the channel for antegrade enemas. Parents should be counseled on the rate of complications and that reoperation or placement of a semi-permanent device may be required in a minority of patients.