Appendicostomy stomas and antegrade colonic irrigation after laparoscopic antegrade continence enema.
BACKGROUND
Children with spina bifida, high anorectal anomalies, or neuronal intestinal dysplasia who are treated with a laparoscopic antegrade continence enema to achieve a socially acceptable level of fecal continence sometimes have problems with the stoma and its catheterization. The goal of this study was to determine the nature and incidence of these problems, and their relationship to the underlying condition.


METHODS
A retrospective review of the hospital case notes of 74 consecutive patients who had a laparoscopic antegrade continence enema was undertaken.


RESULTS
The laparoscopic antegrade continence enema procedure is well tolerated but is associated with a variety of usually minor complications including stomal stenosis, leakage, peristomal infection, granulation tissue overgrowth, mucosal prolapse, abdominal discomfort during irrigation, appendiceal false passage, and ineffective irrigation. Surgical revision of the stoma was required in 19% of the cases in this study, usually because of stenosis and skin overgrowth. Ongoing problems achieving colonic emptying were most likely to occur in patients with an anorectal malformation.


CONCLUSIONS
Overall, the laparoscopic antegrade continence enema provides an effective method of facilitating emptying of the bowel. However, it has a high incidence of minor troublesome problems, with stenosis and skin overgrowth of the stoma being the most common. Younger children tend to have more complications and difficulty performing effective irrigation. Children with anorectal malformations were more likely to require surgical revision of the stoma, and often needed ongoing manual evacuation and bowel washouts despite the laparoscopic antegrade continence enema.
Kim
Jeff
J
Department of Paediatric Surgery, Christchurch Hospital, Christchurch, New Zealand.
Beasley
Spencer W
SW
Maoate
Kiki
K
D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000002:abnormalities / Q000601:surgery; D001065:Appendix / Q000601:surgery*; D002431:Cecostomy; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000150:complications; D004733:Enema / Q000009:adverse effects; D005242:Fecal Incontinence / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D005260:Female; D006627:Hirschsprung Disease / Q000150:complications; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D009520:New Zealand; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D012007:Rectum / Q000002:abnormalities / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012447:Sacrum / Q000002:abnormalities / Q000601:surgery; D016135:Spinal Dysraphism / Q000150:complications; D054047:Surgical Stomas / Q000009:adverse effects; D007507:Therapeutic Irrigation / Q000009:adverse effects / Q000295:instrumentation; D016896:Treatment Outcome