Percutaneous cecostomy: updates in technique and patient care.
OBJECTIVE
To evaluate the authors' 7-year experience with the percutaneous cecostomy procedure and the long-term outcome of the procedure.


METHODS
Since 1994, 163 tube cecostomies for fecal incontinence were performed in patients aged 2-23 years and who weighed 8-72 kg (mean, 32.2 kg). Underlying conditions included spina bifida (n = 106), imperforate anus (n = 53), Klippel-Feil deformity (n = 1), cerebral palsy (n = 1), Hirschsprung disease (n = 1), and paraplegia (n = 1). Ventriculoperitoneal shunts were present in 85 (52%) of the 163 patients. The authors have followed up 124 (76%) of the 163 cecostomy patients. Information regarding enema technique, satisfaction with the procedure, postprocedure problems, and long-term outcome of the procedure was obtained by interviewing either the patients or the parents.


RESULTS
Tube placement was successful in all patients. One hundred ten (89%) of the 124 patients experienced a substantial decrease in the frequency of soiling accidents. The vast majority of patients expressed satisfaction with the procedure; 117 (94%) of the 124 patients rated the cecostomy procedure as better than the bowel control procedure used before. Late complications of the procedure included granulation tissue and accidentally dislodged tubes. Four patients elected to have their tubes removed for aesthetic and tube management reasons. There was no mortality related to the procedure, although one patient died of pneumonia 5 years later.


CONCLUSIONS
The percutaneous cecostomy procedure is a safe and effective method for treating fecal incontinence.
Chait
Peter G
PG
Department of Diagnostic Imaging, Centre for Image Guided Therapy, Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1X8. peter.chait@sickkids.ca
Shlomovitz
Eran
E
Connolly
Bairbre L
BL
Temple
Michael J
MJ
Restrepo
Ricardo
R
Amaral
Joao G
JG
Muraca
Sergio
S
Richards
Helen F
HF
Ein
Sigmund H
SH
D000293:Adolescent; D000328:Adult; D002431:Cecostomy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D005242:Fecal Incontinence / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D013997:Time Factors