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The appendix as a conduit for antegrade continence enemas in patients with anorectal malformations: lessons learned from 163 cases treated over 18 years.

AbstractINTRODUCTION:
The antegrade continence enema (ACE) has been shown to be a safe and effective method for managing fecal incontinence in the pediatric population. The purpose of this study was to examine our experience with the ACE procedure using the appendix as a catheterizable conduit in children with anorectal malformations (ARMs).
METHODS:
We reviewed the charts of all patients who underwent an ACE procedure using the appendix as a catheterizable conduit between January 1992 and January 2010. Preoperative diagnosis (ARM type), operative details, functional outcomes, and postoperative complications were assessed. Technical modifications over time included selective cecoplication, implementation of the umbilical V-V appendicoplasty technique, and laparoscopy for cecal mobilization.
RESULTS:
Mean age was 9.9 ± 0.6 years, and 67% were male. The most common preoperative diagnosis was rectourethral fistula in boys (39%) and persistent cloaca in girls (61%). Forty-five complications occurred in 41 patients with an overall incidence of 25.6% (stricture, 18%; leakage, 6%; prolapse, 4%; intestinal obstruction, 0.6%). The incidence of stomal leakage was lower in patients when a cecoplication was performed (2.9% [4/138] vs 29.4% [5/17]; P < .01), and the incidence of stricture was lower in patients when the umbilical anastomosis was created using the V-V appendicoplasty technique (11% [11/100] vs 30% [18/60]; P < .01). Successful management of incontinence was reported by 96% of all patients.
CONCLUSIONS:
The ACE procedure using the umbilical V-V appendicoplasty provides an effective and cosmetically superior means for bowel management in children with ARMs. The rate of late complications is not insignificant however, and preventative strategies should focus on careful operative technique and ensuring compliance with catheterization protocols well past the initial postoperative period.
AuthorsShawn J Rangel, Taiwo A Lawal, Andrea Bischoff, Kaveer Chatoorgoon, Emily Louden, Alberto Peña, Marc A Levitt
JournalJournal of pediatric surgery (J Pediatr Surg) Vol. 46 Issue 6 Pg. 1236-42 (Jun 2011) ISSN: 1531-5037 [Electronic] United States
PMID21683229 (Publication Type: Evaluation Study, Journal Article)
CopyrightCopyright © 2011 Elsevier Inc. All rights reserved.
Topics
  • Anastomosis, Surgical (methods)
  • Anorectal Malformations
  • Anus, Imperforate (complications, diagnosis, surgery)
  • Appendix (surgery)
  • Child
  • Cohort Studies
  • Enema (methods)
  • Fecal Incontinence (etiology, physiopathology, therapy)
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Patient Satisfaction
  • Postoperative Care (methods)
  • Postoperative Complications (physiopathology, therapy)
  • Quality of Life
  • Plastic Surgery Procedures (adverse effects, methods)
  • Retrospective Studies
  • Severity of Illness Index
  • Statistics, Nonparametric
  • Surgical Stomas
  • Time Factors
  • Treatment Outcome

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