Continent appendicocecostomy for antegrade colonic enema in patients with fecal incontinence Anal inkontinansli hastalarda antegrad kolonik lavman amacli kontinan cekostomi


Emir H. , Besik C., SÖYLET Y.

Pediatrik Cerrahi Dergisi, cilt.13, ss.29-33, 1999 (Diğer Kurumların Hakemli Dergileri) identifier

  • Cilt numarası: 13
  • Basım Tarihi: 1999
  • Dergi Adı: Pediatrik Cerrahi Dergisi
  • Sayfa Sayıları: ss.29-33

Özet

In the Malone antegrade colonic enema (ACE) technique; appendix or neoappendix created from cecum or ileum is brought to the surface of abdominal wall to provide a non-refluxing catheterizable channel that enables antegrade colonic lavage to control fecal incontinence. The aim of this study is to describe the results of ACE procedure in children suffering from fecal incontinence. The records of 12 children who had ACE procedure between 1995- 1999 were reviewed. There were 9 boys and 3 girls with a mean age of 9 years. In all patients who had urinary incontinence due to neuropathic bladder, simultaneous bladder augmentation with formation of Mitrofanoff stoma for continent vesicostomy were performed. In 5 cases tubularized cecal flap, in one case orthotopic appendicocecostomy and in 6 cases tubularized ileal conduits were used. Results were evaluated according to surgical complications and functional success rates which were graded either as full, or partial success or as failure. Full success means totally clean or with minor rectal/stomal soiling, partial success means significant rectal/stomal leakage but improvement, and failure means regular leakage. After a follow up of 2-48 months (mean 25 months) strictures of the stoma requiring surgical revision occurred in 2 patients with cecal flap and in one with transverse tubularized ileal flap. Full success was achieved in 9 patients, whereas partial success was observed in 2. One patient was excluded for short follow up period. The Malone ACE procedure is a safe and highly effective approach to control fecal incontinence in pediatric patients and improves quality of life. If the appendix has been used as a conduit for bladder catheterization, transverse tubularized ileal segment will be preferred to cecal flap because of less complications.