title: Modified technique of antegrade continence enema using a stapling device.
abstract: OBJECTIVE
  We present a stapling technique for constructing an antegrade continence enema (ACE) conduit that is helpful in cases of insufficient appendiceal luminal length or when a concomitant appendiceal Mitrofanoff stoma is required.
  
  
  METHODS
  In 6 patients with a mean age of 9.5 years who required an ACE procedure the cecum was tubularized in continuation with the orthotopic appendix at its base, using a stapling device to construct an ACE conduit. The tubularized segment was imbricated with permanent suture material. In 3 cases appendiceal length after tubularization was sufficient to allow splitting for the concomitant creation of an appendiceal Mitrofanoff stoma.
  
  
  RESULTS
  Patients have been followed an average of 16.5 months. Stomal continence was achieved in all cases as well as reliable catheterization of the appendiceal cecostomy in 6 and the Mitrofanoff conduit in 3.
  
  
  CONCLUSIONS
  This modification of the ACE procedure with cecal tubularization in continuation with the appendix using a stapling device is an excellent approach in cases of inadequate appendiceal length. It successfully creates a catheterizable stoma with a reliable flap valve continence mechanism. The complex reconstructive procedure is simplified by eliminating the need to use tapered small intestine, while allowing the creation of a concomitant appendiceal Mitrofanoff stoma as necessary.
authors.affiliation: Division of Pediatric Urology, Children's Hospital Medical Center, University of Cincinnati, Ohio, USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Sheldon
authors.forename: E
authors.initials: E
authors.lastname: Minevich
authors.forename: J
authors.initials: J
authors.lastname: Wacksman
mesh_terms: D000293:Adolescent; D001065:Appendix / Q000601:surgery; D002432:Cecum / Q000601:surgery; D002648:Child; D004733:Enema; D005242:Fecal Incontinence / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D013528:Surgical Staplers; D014547:Urinary Diversion / Q000379:methods*