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Ileal Neoappendicostomy in the Treatment of Fecal Incontinence in ChildrenFunding None.
Introduction An antegrade colonic enema (ACE) via an appendicostomy has been shown to be effective in the management of functional bowel problems. In cases with a missing appendix, a neoappendicostomy may be considered.
Materials and Methods A retrospective review of clinical outcomes in children who underwent ileal neoappendicostomy for ACE. Medical records were reviewed for data on demography, intra- and postoperative complications. A follow-up questionnaire on stoma problems, ACE-related problems, bowel function, patient satisfaction, well-being, and effect on daily activities was performed.
Results Ten patients were included at an average age of 10.6 years at surgery. In half of the patients, minor postoperative complications (Clavien–Dindo grade 2 or less) were found. Nine patients answered the questionnaire with a mean follow-up of 57 months. Despite complaints of stomal leakage, difficulties with catheterization, and pain during irrigation, they reported a high grade of satisfaction, improvements in well-being, and bowel function and the achievement of continence.
Conclusion Ileal neoappendicostomy may be an alternative to ACE in children with severe and medically intractable constipation and or/and fecal incontinence where the appendix is missing or not available.
Received: 15 March 2020
Accepted: 16 August 2020
15 September 2020 (online)
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- 1 Malone PS, Ransley PG, Kiely EM. Preliminary report: the antegrade continence enema. Lancet 1990; 336 (8725): 1217-1218
- 2 Gor RA, Katorski JR, Elliott SP. Medical and surgical management of neurogenic bowel. Curr Opin Urol 2016; 26 (04) 369-375
- 3 Marsh PJ, Kiff ES. Ileocaecostomy: an alternative surgical procedure for antegrade colonic enema. Br J Surg 1996; 83 (04) 507-508
- 4 Christensen P, Buntzen S, Krogh K, Laurberg S. Ileal neoappendicostomy for antegrade colonic irrigation. Br J Surg 2001; 88 (12) 1637-1638
- 5 Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240 (02) 205-213
- 6 Kudela G, Smyczek D, Springer A, Korecka K, Koszutski T. No appendix is too short-simultaneous Mitrofanoff catheterizable vesicostomy and Malone Antegrade Continence Enema (MACE) for children with spina bifida. Urology 2018; 116: 205-207
- 7 Bevill MD, Bonnett K, Arlen A, Cooper C, Baxter C, Storm DW. Outcomes and satisfaction in pediatric patients with Chait cecostomy tubes. J Pediatr Urol 2017; 13 (04) 365-370
- 8 Yerkes EB, Rink RC, Cain MP, Casale AJ. Use of a Monti channel for administration of antegrade continence enemas. J Urol 2002; 168 (4 Pt 2): 1883-1885
- 9 Herndon CDA, Cain MP, Casale AJ, Rink RC. The colon flap/extension Malone antegrade continence enema: an alternative to the Monti-Malone antegrade continence enema. J Urol 2005; 174 (01) 299-302
- 10 Chatoorgoon K, Pena A, Lawal T, Hamrick M, Louden E, Levitt MA. Neoappendicostomy in the management of pediatric fecal incontinence. J Pediatr Surg 2011; 46 (06) 1243-1249
- 11 Portier G, Ghouti L, Kirzin S, Chauffour M, Lazorthes F. Malone antegrade colonic irrigation: ileal neoappendicostomy is the preferred procedure in adults. Int J Colorectal Dis 2006; 21 (05) 458-460
- 12 Worsøe J, Christensen P, Krogh K, Buntzen S, Laurberg S. Long-term results of antegrade colonic enema in adult patients: assessment of functional results. Dis Colon Rectum 2008; 51 (10) 1523-1528
- 13 Soyer T. Prevention and management of complications in various antegrade enema procedures in children: a review of the literature. Pediatr Surg Int 2020; 36 (06) 657-668
- 14 Rongen MJ, van der Hoop AG, Baeten CG. Cecal access for antegrade colon enemas in medically refractory slow-transit constipation: a prospective study. Dis Colon Rectum 2001; 44 (11) 1644-1649
- 15 Matsuno D, Yamazaki Y, Shiroyanagi Y. et al The role of the retrograde colonic enema in children with spina bifida: is it inferior to the antegrade continence enema?. Pediatr Surg Int 2010; 26 (05) 529-533
- 16 Wide P, Mattsson GG, Drott P, Mattsson S. Independence does not come with the method--treatment of neurogenic bowel dysfunction in children with myelomeningocele. Acta Paediatr 2014; 103 (11) 1159-1164
- 17 Chéreau N, Lefèvre JH, Shields C. et al Antegrade colonic enema for faecal incontinence in adults: long-term results of 75 patients. Colorectal Dis 2011; 13 (08) e238-e242
- 18 Altomare DF, Rinaldi M, Rubini D. et al Long-term functional assessment of antegrade colonic enema for combined incontinence and constipation using a modified Marsh and Kiff technique. Dis Colon Rectum 2007; 50 (07) 1023-1031
- 19 Mohamed H, Wayne C, Weir A, Partridge EA, Langer JC, Nasr A. Tube cecostomy versus appendicostomy for antegrade enemas in the management of fecal incontinence in children: a systematic review. J Pediatr Surg 2020; 55 (07) 1196-1200