The impact of transcutaneous electrical stimulation therapy on appendicostomy operation rates for children with chronic constipation--a single-institution experience.
OBJECTIVE
Appendicostomy for antegrade continence enema is a minimally invasive surgical intervention that has helped many children with chronic constipation. At our institution, since 2006, transcutaneous electrical stimulation (TES) has been trialed to treat slow-transit constipation (STC) in children. This retrospective audit aimed to determine if TES use affected appendicostomy-formation rates and to monitor changes in practice. We hypothesized that appendicostomy rates have decreased for STC but not for other indications.


METHODS
Appendicostomy-formation rate was determined for the 5 years before and after 2006. Children were identified as STC or non-STC from nuclear transit scintigraphy and patient records.


RESULTS
Since 1999, 317 children were diagnosed with STC using nuclear transit scintigraphy with 121 during 2001 to 2005 (24.2/year) and 147 during 2006 to 2010 (29.4/year). Seventy-four children had appendicostomy formation. For 2001 to 2005, appendicostomy-formation rates for STC and non-STC children were similar: 5.4 per year (n = 27) and 4.8 per year (n = 24), respectively. For 2006 to 2010, appendicostomy-formation rates were 1.2 per year (n = 6) for STC and 3.2 per year (n = 16) for non-STC (χ(2), P = .04).


CONCLUSIONS
Since 2006, appendicostomy-formation rates have significantly reduced in STC but not in non-STC children at our institute, coinciding with the introduction of TES as an alternative treatment for STC. Transcutaneous electrical stimulation has not been tested on non-STC children in this period.
F Douglas Stephens Surgical Research and Gut Motility Laboratories, Murdoch Children's Research Institute, Melbourne, Australia.
Yee Ian
YI
Yik
L C Y
LC
Leong
John M
JM
Hutson
Bridget R
BR
Southwell
D002431:Cecostomy / Q000379:methods / Q000706:statistics & numerical data* / Q000639:trends; D002648:Child; D002908:Chronic Disease; D003131:Combined Modality Therapy; D003248:Constipation / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D004733:Enema / Q000379:methods; D005772:Gastrointestinal Transit; D006801:Humans; D008485:Medical Audit; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data / Q000639:trends; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D004561:Transcutaneous Electric Nerve Stimulation; D016896:Treatment Outcome