Impact of cecostomy and antegrade colonic enemas on management of fecal incontinence and constipation: ten years of experience in pediatric population.
BACKGROUND
In childhood and adolescence, fecal soiling represents a psychologically devastating problem. Physical and emotional distress associated with daily rectal enemas is minimized by the introduction of a cecostomy tube for colonic cleansing with antegrade colonic enemas (ACEs).


METHODS
Over a period of 10 years (1997-2007), we performed "button" cecostomies in 69 pediatric patients with fecal soiling secondary to a variety of disorders; laparoscopic procedures were performed in 40 and open procedures in 29. Mean postoperative follow-up was 4.03 SD +/- 1.76 years. Cleansing protocols differed between patients.


RESULTS
We adopted a standardized questionnaire concerning management of incontinence/intractable constipation before and after button cecostomy insertion to assess the long-term impact of ACE on symptom severity and quality of life. Complications included tube dislodgement (n = 9), development of granulation tissue (n = 11), decubitus ulcer (n = 5), and infection (n = 3). Patient/parents satisfaction (appraisal scale 1-3) and improvement of quality of life achieved statistical significance for both (P < .001).


CONCLUSIONS
Since button cecostomy and ACE were introduced in our institution as a management option, the treatment of fecal incontinence and intractable constipation significantly improved in terms of efficacy and patient compliance and also resulted in greater patient and parent satisfaction.
Wong
Andrew L
AL
Pediatric Surgery Department, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada. wongal87@yahoo.ca
Kravarusic
Dragan
D
Wong
Sarah L
SL
D000293:Adolescent; D002431:Cecostomy / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003248:Constipation / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D004733:Enema / Q000379:methods*; D005242:Fecal Incontinence / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods; D008297:Male; D011183:Postoperative Complications / Q000503:physiopathology; D011336:Probability; D011379:Prognosis; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D016896:Treatment Outcome