title: A novel approach to the laparoscopic antegrade continence enema procedure: intracorporeal and extracorporeal techniques.
abstract: OBJECTIVE
  The use of laparoscopic techniques in the construction of an antegrade continence enema (ACE) channel is evolving as a minimally invasive procedure that attempts to address issues of morbidity commonly associated with the technique as originally described. Because of our experience with "open" ACE construction, we maintain that true fecal continence of the ACE channel requires more than dependence on the appendicocecal sphincteric mechanism. Therefore, we have implemented intracorporeal or extracorporeal suturing to create a reliable continence mechanism.
  
  
  METHODS
  We retrospectively reviewed 6 patients who underwent laparoscopic ACE and compared the outcome to 20 consecutive conventional open ACE procedures. Outcome measures included operative time, perioperative pain control, length of hospital stay, channel leakage, stenosis and herniation.
  
  
  RESULTS
  There was no significant difference in operative time between the laparoscopic and conventional groups. The laparoscopic approach was associated with decreased postoperative pain and hospital stay. Difference in complication rates for leakage, stenosis and herniation was insignificant.
  
  
  CONCLUSIONS
  Laparoscopic ACE, performed either completely intracorporeally or with laparoscopic assistance as described, provides another option in the surgical armamentarium to create an antegrade continence enema with decreased postoperative morbidity.
authors.affiliation: Division of Pediatric Urology, Children's Hospital and Regional Medical Center, University of Washington, Seattle, 98105, USA. pat.casale@seattlechildrens.org
authors.forename: Pasquale
authors.initials: P
authors.lastname: Casale
authors.forename: Richard W
authors.initials: RW
authors.lastname: Grady
authors.forename: Waldo C
authors.initials: WC
authors.lastname: Feng
authors.forename: Byron D
authors.initials: BD
authors.lastname: Joyner
authors.forename: Michael E
authors.initials: ME
authors.lastname: Mitchell
mesh_terms: D000293:Adolescent; D001065:Appendix / Q000601:surgery*; D004733:Enema / Q000379:methods*; D005242:Fecal Incontinence / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D012189:Retrospective Studies; D013536:Suture Techniques