title: Laparoscopic-Assisted Percutaneous Endoscopic Cecostomy (LAPEC) in Children and Young Adults.
abstract: We evaluated the safety and efficacy of the laparoscopic-assisted percutaneous endoscopic cecostomy (LAPEC) procedure both in children and young adults, along with review of their pre-operative motility profiles, antegrade continence enema (ACE) regimen, and postoperative complications.
  
  
  
  This retrospective review investigated 38 patients (32 children and 6 young adults) that underwent the LAPEC procedure. Primary outcomes evaluated were success versus failure of the procedure and post-operative complications. Success was defined as daily stool evacuation with minimal to no fecal incontinence per week.
  
  
  
  Mean follow up time was 25.8 ± 22.4 months. Indications for LAPEC included slow transit constipation or colonic neuropathy (n = 22), other types of constipation (n = 5), and a variety of congenital disorders (n = 11). The overall success rate was 95% (36/38 patients) with the two failures in children, both attributed to inability to use the tube due to underlying behavioral disorders or severe anxiety. Five patients above age 18 had leakage compared to 6 in the under age 18 group (83% vs. 19, P = 0.003). There were no other significant complications.
  
  
  
  LAPEC is a safe and effective means of addressing refractory constipation and fecal incontinence in children and young adults who have failed medical management with minimal post-operative complications.
authors.affiliation: Division of Pediatric Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.|Department of Pediatric Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Shifra
authors.initials: S
authors.lastname: Koyfman
authors.affiliation: Department of Pediatric Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Kristen
authors.initials: K
authors.lastname: Swartz
authors.affiliation: Department of Pediatric Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.|Center for Neurointestinal Health, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Allan M
authors.initials: AM
authors.lastname: Goldstein
authors.affiliation: Center for Neurointestinal Health, Massachusetts General Hospital, Boston, MA, USA. kstaller@mgh.harvard.edu.|Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. kstaller@mgh.harvard.edu.
authors.forename: Kyle
authors.initials: K
authors.lastname: Staller
mesh_terms: D000293:Adolescent; D000328:Adult; D002431:Cecostomy / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003108:Colonic Diseases / Q000150:complications / Q000601:surgery; D003248:Constipation / Q000209:etiology / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D004733:Enema; D005242:Fecal Incontinence / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005769:Gastrointestinal Motility; D030342:Genetic Diseases, Inborn / Q000150:complications / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D010523:Peripheral Nervous System Diseases / Q000150:complications / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Antegrade continence enema (ACE); Complications; Motility evaluation