title: Initial experience with laparoscopic Chait Trapdoor cecostomy catheter placement for the management of fecal incontinence in children: outcomes and lessons learned.
abstract: BACKGROUND
  Antegrade enemas administered through a percutaneously placed Chait Trapdoor cecostomy catheter have resulted in a marked improvement in compliance and outcome of patients with fecal incontinence. The percutaneous technique, however, is a two-step procedure that is not performed under direct vision. This report presents the results and lessons learned from our experience with the laparoscopic approach to placement of Chait cecostomy catheters.
  
  
  METHODS
  Retrospective review of patients who underwent laparoscopic placement of Chait cecostomy catheters from 1999 to 2008. Data collected included patient demographics, primary diagnosis, hospital stay, complications, follow-up duration and outcome.
  
  
  RESULTS
  Seventeen patients, mean age 11.8 + or - 4.2 years (range 5-17), underwent laparoscopic Chait cecostomy catheter placement over a period of 8 years. Median follow-up was 46 + or - 21 months (range 4-67). The primary diagnosis was spina bifida in 82% of patients. There was one intraoperative complication, which consisted of tangential needle placement into the cecum, and required conversion to an open procedure. Mean hospital stay was 3.8 + or - 1.5 days (range 2-7). Emergency department visits related to Chait catheter complications were mainly due to catheter dislodgement and breakage. Long-term complications included accidental dislodgement of the catheter in seven patients (41%), mechanical failure of the catheter (breaks/leaks) in six patients (35%), hypertrophic granulation tissue in six patients (35%), wound infections at the catheter site in three patients (18%), complications related to the use of fasteners in two patients (12%) and ventirculoperitoneal (VP) shunt infection in two patients (11.8%).
  
  
  CONCLUSIONS
  The laparoscopic approach to Chait cecostomy catheter placement is a simple and effective procedure. The rate of long term complications such as catheter dislodgement and mechanical failure, which are responsible for the majority of unplanned ED visits, may be decreased by routine yearly catheter exchanges. VP shunt infections are the most serious complications in this patient population consisting mostly of patients with spina bifida.
authors.affiliation: Division of Pediatric Surgery, Women and Children's Hospital of Buffalo, 219 Bryant Street, Buffalo, NY 14222, USA. syamout@kaleidahealth.org
authors.forename: Sani Ziad
authors.initials: SZ
authors.lastname: Yamout
authors.forename: Philip L
authors.initials: PL
authors.lastname: Glick
authors.forename: Yi-Horng
authors.initials: YH
authors.lastname: Lee
authors.forename: Dean V
authors.initials: DV
authors.lastname: Yacobucci
authors.forename: Stanley T
authors.initials: ST
authors.lastname: Lau
authors.forename: Mauricio A
authors.initials: MA
authors.lastname: Escobar
authors.forename: Michael G
authors.initials: MG
authors.lastname: Caty
mesh_terms: D000293:Adolescent; D002404:Catheterization / Q000295:instrumentation*; D002431:Cecostomy / Q000295:instrumentation*; D002648:Child; D002675:Child, Preschool; D003672:Defecation; D004867:Equipment Design; D005242:Fecal Incontinence / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D012189:Retrospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome