Impact of cecostomy and antegrade colonic enemas on management of fecal incontinence and constipation. Ten years of experience in pediatric population

Andrew L. Wong, Dragan Kravarusic, Sarah L. Wong

Research output: Contribution to journalArticlepeer-review

37 Scopus citations

Abstract

Background: In childhood and adolescence, fecal soiling represents a psychologically devastating problem. Physical and emotional distress associated with daily rectal enemas is minimized by the introduction of a cecostomy tube for colonic cleansing with antegrade colonic enemas (ACEs). Patients and Methods: Over a period of 10 years (1997-2007), we performed "button" cecostomies in 69 pediatric patients with fecal soiling secondary to a variety of disorders; laparoscopic procedures were performed in 40 and open procedures in 29. Mean postoperative follow-up was 4.03 SD ± 1.76 years. Cleansing protocols differed between patients. Results: We adopted a standardized questionnaire concerning management of incontinence/intractable constipation before and after button cecostomy insertion to assess the long-term impact of ACE on symptom severity and quality of life. Complications included tube dislodgement (n = 9), development of granulation tissue (n = 11), decubitus ulcer (n = 5), and infection (n = 3). Patient/parents satisfaction (appraisal scale 1-3) and improvement of quality of life achieved statistical significance for both (P < .001). Conclusions: Since button cecostomy and ACE were introduced in our institution as a management option, the treatment of fecal incontinence and intractable constipation significantly improved in terms of efficacy and patient compliance and also resulted in greater patient and parent satisfaction.

Original languageEnglish
Pages (from-to)1445-1451
Number of pages7
JournalJournal of Pediatric Surgery
Volume43
Issue number8
DOIs
StatePublished - 1 Aug 2008
Externally publishedYes

Keywords

  • Antegrade colonic enema
  • Cecostomy
  • Fecal incontinence
  • Laparoscopy
  • Spina bifida

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