title: Treatment of a leaking ACE conduit with Deflux injections.
abstract: Faecal leakage from the catheter conduit can be troublesome and reduces the convenience of use of antegrade continence enema (ACE). We report the results of Deflux injection treatment for leaking ACE conduits in nine patients. From 1994 to the end of 2005, 81 patients underwent a procedure for ACE [appendicostomy with wrap (AW) n = 29, appendicostomy straight (AS) n = 44, Monti-Yang ileal tube (MY) n = 5, lateral caecal flap (LCF) n = 1, caecal tube (CT) n = 1, sigmoid tube (ST) n = 1]. Nine (11%) patients (AW n = 3, AS n = 1, MY n = 3, LCF n = 1, ST n = 1) had persistent stomal leak and underwent Deflux injections of the ACE conduit. With the patients in general anaesthesia, the conduit was visualised with CH10.5 cystoscope. At the junction of the conduit and colon, 0.5-1.0 ml of Deflux was injected submucosally at three sites to create intermingling mounds in order to narrow the conduit. After the injections, a balloon catheter was left in the conduit for 3-7 days. When necessary, the injections were repeated. The result was graded as no improvement, moderate improvement, significant improvement. Nine patients underwent a median of 2 (range 1-4) injections. No major complications occurred. The results after a median follow-up of 22 (range 3-53) months from the first injection were as follows: no improvement (n = 1), moderate improvement (n = 5), significant improvement (n = 3). Repeated injection of the ACE conduit with Deflux is a low invasive method and provides moderate to good results in the majority of the patients who suffer from faecal leakage from conduit.
authors.affiliation: Hospital for Children and Adolescents, University of Helsinki, Helsinki 000290, Finland. antti.koivusalo@hus.fi
authors.forename: A
authors.initials: A
authors.lastname: Koivusalo
authors.forename: M P
authors.initials: MP
authors.lastname: Pakarinen
authors.forename: R J
authors.initials: RJ
authors.lastname: Rintala
mesh_terms: D000293:Adolescent; D000328:Adult; D001065:Appendix / Q000601:surgery; D001672:Biocompatible Materials / Q000008:administration & dosage*; D002404:Catheterization; D002648:Child; D003125:Colostomy / Q000379:methods*; D003911:Dextrans / Q000008:administration & dosage*; D013505:Digestive System Surgical Procedures; D004733:Enema / Q000379:methods*; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007267:Injections; D007902:Length of Stay; D008297:Male; D012189:Retrospective Studies
chemical_list: D001672:Biocompatible Materials; D003911:Dextrans; C094535:deflux; D006820:Hyaluronic Acid