title: Neoappendicostomy in the management of pediatric fecal incontinence.
abstract: OBJECTIVE
  The Malone appendicostomy, for antegrade enemas, has improved the quality of life for many children with fecal incontinence. In patients whose appendix has been removed, a neo-appendix can be created. We describe our approach and experience with this procedure as an option for surgeons managing children with fecal incontinence.
  
  
  METHODS
  The procedure involves creating a transverse flap of cecum that receives its blood supply by a transverse mesenteric branch. This flap is then tubularized around a feeding tube. The surrounding colon is plicated around the neo-appendix to prevent leakage of stool. The tip of the flap is then anastomosed to the deepest portion of the umbilicus. We reviewed our experience with this procedure, including results and complications. IRB approval was obtained.
  
  
  RESULTS
  Eighty patients required a neo-appendicostomy. Sixty-six patients (82%) had an anorectal malformation, four had spina bifida, and ten had other diagnoses. The reasons for not having an appendix available included: "incidental" appendectomy (34, 42.5%), use of the appendix for a Mitrofanoff procedure (20, 25%), and Ladd's procedure (5, 6%). In fifteen patients (19%) we could find no appendix and assume that it was removed previously. Following neoappendicostomy, nine patients (11%) developed a stricture, and seven patients had leakage (9%). In 2004, we modified the appendiceal-umbilical anastomosis and among these patients, only one patient (3%) developed a stricture, compared with eight patients (18%) without the modification. All seven patients with leakage were within the first forty cases. No patient in the last forty cases had a leakage.
  
  
  CONCLUSIONS
  In patients with the potential for fecal incontinence, the appendix should be preserved. In patients without an appendix, the neo-appendicostomy is a valuable tool for fecally incontinent patients. We have found that the V-V anastomosis had a reduced rate of stricture, and the rate of leakage seems to be related to surgical experience.
authors.affiliation: Colorectal Center for Children, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
authors.forename: Kaveer
authors.initials: K
authors.lastname: Chatoorgoon
authors.forename: Alberto
authors.initials: A
authors.lastname: Pena
authors.forename: Taiwo
authors.initials: T
authors.lastname: Lawal
authors.forename: Miller
authors.initials: M
authors.lastname: Hamrick
authors.forename: Emily
authors.initials: E
authors.lastname: Louden
authors.forename: Marc A
authors.initials: MA
authors.lastname: Levitt
mesh_terms: D000293:Adolescent; D000714:Anastomosis, Surgical / Q000379:methods; D001065:Appendix / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004733:Enema / Q000379:methods*; D005242:Fecal Incontinence / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017060:Patient Satisfaction; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D054047:Surgical Stomas; D016896:Treatment Outcome; D014472:Umbilicus / Q000601:surgery