title: Antegrade continent enema procedures performed prior to starting school may improve functional stooling and quality of life.
abstract: OBJECTIVE
  A major research gap is determining the best age to perform an appendicostomy or cecostomy. This study hypothesizes that performance of appendicostomy/cecostomy prior to starting school (<6 years) would improve functional stooling and quality of life (QOL).
  
  
  METHODS
  Patients who underwent appendicostomy/cecostomy for bowel management between 2003 and 2013 were retrospectively identified. Families were prospectively surveyed regarding current stooling habits (17 items) and a (7 item) pediatric QOL survey. Lower stooling survey scores represent better bowel control. Higher QOL scores indicated better quality. The primary outcome was to correlate age of appendicostomy/cecostomy to QOL score. Statistics were performed using paired, unpaired t tests, and Chi-square. p Values ≤0.05 were considered significant.
  
  
  RESULTS
  35 patients underwent placement of appendicostomy/cecostomy. Fourteen (40%) patients/families were prospectively contacted (<6, n = 6; >6, n = 8). Stooling scores (15.17 ± 1.35 vs. 22.25 ± 1.70; for <6 vs. >6 years old, p = 0.009) and continence scores (6.33 ± 1.45 vs. 11.13 ± 1.64; p = 0.06), at time of contacting families, were significantly better in those undergoing appendicostomy/cecostomy in the <6 group. Pre-procedure QOL scores for the two groups were similar (p = 0.89). Post-procedure QOL significantly increased to the good subcategory for both age groups; however improvement was significantly better in the <6 age group vs. ≥6 group: 6.33 ± 0.92 vs. 3.13 ± 0.91 points (p = 0.03). A secondary parent survey showed significantly more families wished an appendicostomy/cecostomy were done earlier in the >6 vs. <6 group (87.5 vs. 33%; p = 0.04).
  
  
  CONCLUSIONS
  Early placement of cecostomy or appendicostomy as part of a bowel management program may contribute to improved QOL and functional stooling.
authors.affiliation: Section of Pediatric Surgery, Department of Surgery, University of Michigan Health System, Mott Children's Hospital, 1540 E. Hospital Dr., SPC 4211, Ann Arbor, MI, 48109-4211, USA, jennjfreeman@me.com.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Freeman
authors.forename: Siddartha
authors.initials: S
authors.lastname: Simha
authors.forename: Marcus D
authors.initials: MD
authors.lastname: Jarboe
authors.forename: Peter F
authors.initials: PF
authors.lastname: Ehrlich
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Teitelbaum
mesh_terms: D002648:Child; D003248:Constipation / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D003672:Defecation / Q000502:physiology*; D004733:Enema / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011788:Quality of Life; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome