Short-term outcomes of Chait Trapdoor for antegrade continence enema in adults.
OBJECTIVE
To examine our short-term experience of antegrade continence enema (ACE) delivered via a Chait Trapdoor (Cook Medical, Bloomington, IN) in adults with intractable neurogenic bowel.


METHODS
We performed a retrospective review at the Universities of Utah and Minnesota of 15 patients with Chait Trapdoor placed for the purpose of ACE from 2011 to 2013. Our primary outcome was continued utilization of the Chait Trapdoor. Secondary outcomes included volume of ACE used and time to produce a bowel movement.


RESULTS
All patients had neurogenic bowel refractory to conventional bowel regimen. Mean follow-up was 6 months (range, 1-17 months). Thirteen patients had the Chait Trapdoor placed in the splenic flexure and 2 had it placed in the cecum. Of the 15 patients, 12 (80%) were still using the Chait Trapdoor at last follow-up. A median of 425 mL (range, 120-1000 mL) of fluid was used to produce a bowel movement in 5-120 minutes. Two patients developed postoperative wound infections, requiring return to the operating room (Clavien IIIb). Long-term complications included 5 patients with a dislodged tube requiring replacement by interventional radiology and 2 patients with local cellulitis. Two patients had the Chait Trapdoor moved to a new location to improve efficacy.


CONCLUSIONS
Although the revision, removal, and complication rates were high, 80% of the patients were satisfied with the function and continued to use the Chait Trapdoor. The volume of irrigation required for ACE and the time it takes to produce a bowel movement vary significantly between patients.
Department of Surgery and the Center for Reconstructive Urology and Men's Health, University of Utah, Salt Lake City, UT. Electronic address: jeremy.myers@hsc.utah.edu.
Jeremy B
JB
Myers
Department of Surgery and the Center for Reconstructive Urology and Men's Health, University of Utah, Salt Lake City, UT.
Eric M
EM
Hu
Department of Urology, University of Minnesota, Minneapolis, MN.
Sean P
SP
Elliott
Department of Urology, University of Minnesota, Minneapolis, MN.
Andrew
A
Nguyen
Department of Urology, University of Minnesota, Minneapolis, MN.
Patrick
P
Hovert
Department of Surgery and the Center for Reconstructive Urology and Men's Health, University of Utah, Salt Lake City, UT.
William O
WO
Brant
Department of Surgery and the Center for Reconstructive Urology and Men's Health, University of Utah, Salt Lake City, UT.
Blake D
BD
Hamilton
Department of Surgery and the Center for Reconstructive Urology and Men's Health, University of Utah, Salt Lake City, UT.
M Chad
MC
Wallis
Department of Surgery and the Center for Reconstructive Urology and Men's Health, University of Utah, Salt Lake City, UT.
Jeffrey D
JD
Redshaw
D000328:Adult; D000368:Aged; D002431:Cecostomy / Q000379:methods*; D015331:Cohort Studies; D020878:Device Removal; D004733:Enema / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D004867:Equipment Design; D004869:Equipment Safety; D005242:Fecal Incontinence / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D010528:Peristalsis / Q000502:physiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D019919:Prosthesis Implantation; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013154:Spleen / Q000601:surgery; D007507:Therapeutic Irrigation / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome