Since 2002, patients with
fecal incontinence or
encopresis and
constipation underwent percutaneous
cecostomy under laparoscopy using a button. Technical details are described. Age at surgery,
operative time,
hospital stay, diagnosis, indications for
cecostomy, and duration of follow-up were recorded. A survey was proposed via a questionnaire that was sent to the patients. Patients wearing the button for less than 1 month were excluded from this evaluation. The survey concerned volume and frequency of
enemas, difficulties encountered, benefits and disadvantages of this method, and assessment of the antegrade
enemas in continence.
RESULTS: Twenty-nine patients, 18 males and 11 females, aged 3 to 21 years (mean, 8.5 years) underwent laparoscopic Trap-door button placement. The indications for all the patients were intractable
fecal incontinence in 24 cases and
constipation with
encopresis in 5 cases. Incontinence was because of
myelomeningocele (n = 10),
anorectal malformations (n = 11), caudal regression syndrome (n = 1), 22q11 syndrome (n= 1), and
Hirschsprung disease with
encephalopathy with convulsions (n = 1).
Constipation with
encopresis was because of sacrococcygeal
teratoma (n = 1),
cerebral palsy (n = 1), and acquired megarectum with psychiatric and social disorders (n = 3). A total of 26
cecostomy button placements and 3 sigmoidostomy button placements were successful with no
intraoperative complication. The mean
operative time was 25 minutes (10-40 minutes), and the
hospital stay was 2.5 days (1-4 days). Twenty-two parents or patients answered the questionnaire. At the time of this survey, 2 patients had improved their fecal continence and had had the button removed. A mean of 4 weekly
enemas was enough to improve fecal continence troubles (range, 1 daily to 1 for 2 weeks). The volume for
enemas was 250 to 1000 mL (mean, 700 mL). The time required for the irrigation of the bowel by gravity took from 5 to 60 minutes (mean, 25 minutes) for 20 patients. Before surgery, 14 patients needed a diaper, day and night, and 6 needed sanitary protection. Soiling was a very significant inconvenience for all the patients. After surgery, only 5 patients needed a diaper (
cerebral palsy, 22q11, cloacal malformation,
myelomeningocele,
bladder exstrophy) because of moderate results or
urinary incontinence and continued soiling. Patients were asked to give an assessment (null = 0, bad = 1, fair = 2, good = 3, very good = 4). None of the patients felt there had been no changes or a bad result. There were 5 patients who felt they had an average result, 5 a good result, and 12 a very good result. The mean grade was 3.44 (17.2/20). A total of 3 patients had hypertrophic granulation tissue formation around the
cecostomy button, and 12 had tiny leakage.
CONCLUSION: Percutaneous placement of a
cecostomy button under laparoscopic control is an easy and major complication-free procedure. The use of the Trap-door device by the patients or with the help of the parents for antegrade
enemas is effective and satisfactory. It improves the quality of life and is reversible.