title: Appendicostomy in preschool children with anorectal malformation: successful early bowel management with a high frequency of minor complications.
abstract: OBJECTIVE
  The aim of this study is to evaluate postoperatively bowel symptoms of antegrade colon enema through appendicostomies in preschool children with anorectal malformation (ARM).
  
  
  METHODS
  164 children with ARM operated on with posterior sagittal anorectal plasty were included. The malformations were classified according to Krickenbeck classification. Seventeen children in preschool age had an appendicostomy. The bowel symptoms according to the Krickenbeck follow-up were analysed pre- and postoperatively. All complications were registered. A questionnaire on the use of the appendicostomy was answered.
  
  
  RESULTS
  The median age (range) at the time of the appendicostomy was 4 (1-6) years. The observation time was 5 (0.5-14) years. The main indications for appendicostomy were incontinence and noncompliance to rectal enemas. Postoperatively there was a significant decrease in soiling and constipation (P < 0.001). The total complication rate was 43% with infections (29%), stenosis (12%), and retrograde leakage (0). The median time required for giving enema in the appendicostomy was 45 minutes (range: 15-120) once a day varying from 2 times/week to 3 times/day. And: complications are less frequent than in older children.
  
  
  CONCLUSIONS
  Appendicostomy in preschool children with ARM is a way to achieve fecal cleanness before school start. The infection rate was high, but other complications are less frequent than in older children.
authors.affiliation: The Department of Pediatric Surgery, Skåne University Hospital, 221 85 Lund, Sweden ; Lund University, 221 00 Lund, Sweden.
authors.forename: Pernilla
authors.initials: P
authors.lastname: Stenström
authors.forename: Christina
authors.initials: C
authors.lastname: Granéli
authors.forename: Martin
authors.initials: M
authors.lastname: Salö
authors.forename: Kristine
authors.initials: K
authors.lastname: Hagelsteen
authors.forename: Einar
authors.initials: E
authors.lastname: Arnbjörnsson
mesh_terms: D000071056:Anorectal Malformations; D001006:Anus, Imperforate / Q000601:surgery*; D001065:Appendix / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D010030:Ostomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology*; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors