Appendicostomy for antegrade enema: effects on somatic and psychosocial functioning in children with myelomeningocele.
OBJECTIVE
To assess changes in somatic variables, psychosocial functioning, mental health and self-esteem after appendicostomy for antegrade enema (MACE) in children with myelomeningocele (MMC).


METHODS
We performed the MACE procedure in 20 children, aged 6.3 to 17.0 years. Twelve patients had an open and 8 had a laparoscopic operation. Somatic function was assessed preoperatively and 6 and 16 months postoperatively. Psychosocial functioning and mental health were assessed preoperatively and 6 months postoperatively by a structured clinical interview and standardized questionnaires, Youth Self-Report, Child Behavior Checklist, and Harter's Self-Perception Profile for Adolescents.


RESULTS
Preoperatively, 9 patients had fecal leaks several times a week, 7 had leaks 1 to 4 times per month, and 4 were continent. The corresponding numbers 6 and 16 months postoperatively were 0, 6, and 14 and 0, 3, and 16. Six patients have had postoperative stoma complications that required surgery; 5 had a well-functioning stoma thereafter, and 1 had a colostomy 7 months later. Preoperatively, 14 patients reported considerable, 4 moderate, 2 minor, and 0 no psychosocial problems related to bowel control and emptying regimen. Six months postoperatively, the corresponding numbers were 1, 2, 6, and 11. The standardized questionnaires revealed substantial psychopathology in the MMC patients. The Child Behavior Checklist and Youth Self-Report scores were not significantly changed postoperatively, but global self-esteem score and close friends score from the Self-Perception Profile for Adolescents were significantly improved.


CONCLUSIONS
Fecal incontinence and constipation were greatly reduced by MACE. Children with MMC often have psychological and psychosocial problems, but important improvements in self-esteem and psychosocial function were observed 6 months after the MACE procedure.
Aksnes
Gunnar
G
Department of Surgery, The National Hospital, University of Oslo, Oslo, Norway.
Diseth
Trond H
TH
Helseth
Are
A
Edwin
Bjørn
B
Stange
Marianne
M
Aafos
Gabrielle
G
Emblem
Ragnhild
R
D000293:Adolescent; D001065:Appendix / Q000601:surgery*; D016022:Case-Control Studies; D002648:Child; D003125:Colostomy; D003248:Constipation / Q000209:etiology / Q000601:surgery; D004733:Enema / Q000523:psychology; D004766:Enterostomy; D005242:Fecal Incontinence / Q000209:etiology / Q000523:psychology / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008591:Meningomyelocele / Q000150:complications* / Q000523:psychology / Q000601:surgery; D011183:Postoperative Complications; D012649:Self Concept; D054047:Surgical Stomas