title: New surgical technique for creation of a continent appendicostomy: Invaginated appendicostomy.
abstract: BACKGROUND
  The main complications of appendicostomy are stenosis and stomal fecal leakage. Although many authors report that the appendix is naturally continent, it is recommended to perform a plication of the cecum with the appendix to prevent stomal fecal leakage. We present here the creation of a different continent mechanism. Our technique is advantageous when the anatomy, vascularity, or the length of the appendix does not allow for a standard plication procedure.
  During 2014-2016 we performed four appendicostomies in patients with anorectal malformations with fecal incontinence that requested an "Antegrade Continent Enema" procedure after a successful bowel management program in the Colorectal Center for Children of Mexico. The average age at surgery was 13years. All patients had anorectal malformations with a poor prognosis for proper control of defecation, with a sacral ratio lower than 0.4. In these patients, we invaginated a 1cm length of the appendix at its base, placing eight circumferential stitches with 5-0 silk. None of the patients experienced leakage when a saline solution was introduced with a catheter into the cecum during the surgical procedure. After an average of 15months of follow-up, none of the patients were experiencing stomal leakage.
  
  
  CONCLUSIONS
  The "Invaginated Appendicostomy" is a reproducible and effective continent mechanism to prevent stomal fecal leakage. It appears to be an excellent alternative to cecal plication around the appendix.
authors.affiliation: Centro Colorrectal para Niños de México, Hospital Ángeles Puebla, Avenida Kepler 2143-530, Puebla, Mexico, 72190. Electronic address: mariazornoza@gmail.com.
authors.forename: Maria
authors.initials: M
authors.lastname: Zornoza
authors.affiliation: Centro Colorrectal para Niños de México, Hospital Ángeles Puebla, Avenida Kepler 2143-530, Puebla, Mexico, 72190. Electronic address: cirugiapediatrica@msn.com.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Ruiz-Montañez
authors.affiliation: Hospital para el Niño Poblano, Boulevard del Niño Poblano 5307, Puebla, Mexico 72190. Electronic address: guivic@me.com.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Victoria-Morales
authors.affiliation: Colorectal Center for Children of Children's Hospital Pittsburgh of UPMC, Children's Hospital of Pittsburgh of UPMC, One Children's Hospital Drive 4401 Penn Avenue, Pittsburgh, PA 15224, USA. Electronic address: luis.delatorre@chp.edu.
authors.forename: Luis De
authors.initials: L
authors.lastname: la Torre-Mondragón
mesh_terms: D000293:Adolescent; D000071056:Anorectal Malformations / Q000150:complications*; D001065:Appendix / Q000601:surgery*; D002648:Child; D004766:Enterostomy / Q000379:methods*; D005242:Fecal Incontinence / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D016896:Treatment Outcome
keywords: Anorectal malformation; Antegrade continent enema; Fecal incontinence; Invaginated appendicostomy; Malone procedure