title: Laparoscopic-assisted percutaneous endoscopic cecostomy in children with defecation disorders (with video).
abstract: BACKGROUND
  The antegrade continence enema (ACE) procedure has been widely used in the management of children with defecation disorders. The ACE procedure has undergone many technical modifications. We developed a safe and minimally invasive technique, the laparoscopic-assisted percutaneous endoscopic cecostomy (LAPEC).
  
  
  OBJECTIVE
  To compare LAPEC to laparoscopic cecostomy in terms of operative time, hospital length of stay, and procedure-related morbidity.
  
  
  METHODS
  Retrospective review of children undergoing the ACE procedure.
  
  
  METHODS
  Two tertiary-care centers.
  
  
  METHODS
  This study involved children with defecation disorders.
  
  
  METHODS
  The ACE procedure.
  
  
  METHODS
  Procedure complications, length of stay, and operative time.
  
  
  RESULTS
  Fifty patients underwent LAPEC, and 15 underwent laparoscopic cecostomy. Of the LAPEC patients, 70% were male, with mean age 12 ± 4.2 years, mean operative time 100.1 ± 16.6 minutes, and mean length of stay 3.4 ± 1.4 days. Of the laparoscopic cecostomy patients, 56% were male, with mean age 10.5 ± 4 years, mean operative time 100.8 ± 19.1 minutes, and mean length of stay 3.8 ± 1.6 days. There was no statistical difference between the 2 groups. The single intraoperative complication during LAPEC was a cecal hematoma. Postoperative complications after LAPEC included 6 patients with low-grade fever, 3 patients with tube dislodgement (2 treated by repeat LAPEC and the other by open surgery), and 2 patients with skin breakdown. Of the 50 LAPEC patients and their families, 48 were satisfied with the outcome.
  
  
  CONCLUSIONS
  Retrospective study.
  
  
  CONCLUSIONS
  LAPEC is a safe, minimally invasive procedure for cecostomy placement in children with refractory constipation or fecal incontinence.
authors.affiliation: Division of Gastroenterology, Department of Pediatrics, Children’s Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115, USA. Leonel.rodriguez@childrens.harvard.edu
authors.forename: Leonel
authors.initials: L
authors.lastname: Rodriguez
authors.forename: Alejandro
authors.initials: A
authors.lastname: Flores
authors.forename: Brian F
authors.initials: BF
authors.lastname: Gilchrist
authors.forename: Allan M
authors.initials: AM
authors.lastname: Goldstein
mesh_terms: D000293:Adolescent; D002431:Cecostomy / Q000009:adverse effects / Q000379:methods*; D002648:Child; D003248:Constipation / Q000628:therapy*; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000379:methods*; D004733:Enema; D005242:Fecal Incontinence / Q000628:therapy*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D012189:Retrospective Studies; D013996:Time and Motion Studies