A comparison of Malone appendicostomy and cecostomy for antegrade access as adjuncts to a bowel management program for patients with functional constipation or fecal incontinence.

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  • Additional Information
    • Source:
      Publisher: Saunders Country of Publication: United States NLM ID: 0052631 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1531-5037 (Electronic) Linking ISSN: 00223468 NLM ISO Abbreviation: J Pediatr Surg Subsets: MEDLINE
    • Publication Information:
      Publication: Philadelphia, PA : Saunders
      Original Publication: New York.
    • Subject Terms:
      Cecostomy/*adverse effects ; Colostomy/*adverse effects ; Constipation/*surgery ; Fecal Incontinence/*surgery ; Postoperative Complications/*epidemiology; Adolescent ; Adult ; Appendix/surgery ; Cecostomy/methods ; Child ; Child, Preschool ; Colostomy/methods ; Enema/adverse effects ; Enema/methods ; Female ; Humans ; Length of Stay/statistics & numerical data ; Male ; Postoperative Complications/etiology ; Retrospective Studies ; Young Adult
    • Abstract:
      Background: Appendicostomy and cecostomy are two approaches for antegrade enema access for children with severe constipation or fecal incontinence as adjuncts to a mechanical bowel management program. Each technique is associated with a unique set of complications. The purpose of our study was to report the rates of various complications associated with antegrade enema access techniques to help guide which option a clinician offers to their patients.
      Methods: We reviewed all patients in our Center who received an appendicostomy or cecostomy from 2014 to 2017 who were participants in our bowel management program.
      Results: 204 patients underwent an antegrade access procedure (150 appendicostomies and 54 cecostomies). Skin-level leakage (3% vs. 22%) and wound infections (7% vs. 28%) occurred less frequently in patients with appendicostomy compared to cecostomy. Nineteen (13%) appendicostomies required revision for stenosis, 4 (3%) for mucosal prolapse, and 1 (1%) for leakage. The rates of stenosis (33 vs. 12%) and wound infection (13 vs. 6%) were higher in patients who received a neoappendicostomy compared to an in situ appendicostomy. Intervention was needed in 19 (35%) cecostomy patients, 15 (28%) for an inability to flush or a dislodged tube, and 5 for major complications including intraperitoneal spillage in 4 (7%) and 1 (2%) for a tube misplaced in the ileum, all occurring in patients with a percutaneously placed cecostomy. One appendicostomy (1%) patient required laparoscopic revision after the appendicostomy detached from the skin.
      Conclusion: Patients had a lower rate of minor and major complications after appendicostomy compared to cecostomy. The unique complication profile of each technique should be considered for patients needing these procedures as an adjunct to their care for constipation or fecal incontinence.
      Type of Study: Retrospective comparative study.
      Level of Evidence: Level III.
      (Copyright © 2018 Elsevier Inc. All rights reserved.)
    • Contributed Indexing:
      Keywords: Antegrade enema; Bowel management; Cecostomy; Constipation; Fecal incontinence; Malone appendicostomy; Neoappendicostomy
    • Publication Date:
      Date Created: 20181027 Date Completed: 20190304 Latest Revision: 20190304
    • Publication Date:
      20231215
    • Accession Number:
      10.1016/j.jpedsurg.2018.10.008
    • Accession Number:
      30361073