Impact of cecostomy and antegrade colonic enemas on management of fecal incontinence and constipation: Ten years of experience in pediatric population

Andrew L. Wong, Dragan Kravarusic, Sarah L. Wong Impact of cecostomy and antegrade colonic enemas on management of fecal incontinence and constipation: Ten years of experience in pediatric population Journal of Pediatric Surgery, Volume 43, Issue 8, August 2008, Pages 1445-1451


Abstract
Background: In childhood and adolescence, fecal soiling represents a psychologically devastating problem. Physical and emotional distress associated with daily rectal enemas is minimized by the introduction of a cecostomy tube for colonic cleansing with antegrade colonic enemas (ACEs).

Patients and Methods: Over a period of 10 years (1997-2007), we performed “button” cecostomies in 69 pediatric patients with fecal soiling secondary to a variety of disorders; laparoscopic procedures were performed in 40 and open procedures in 29. Mean postoperative follow-up was 4.03 SD ± 1.76 years. Cleansing protocols differed between patients.

Results: We adopted a standardized questionnaire concerning management of incontinence/intractable constipation before and after button cecostomy insertion to assess the long-term impact of ACE on symptom severity and quality of life. Complications included tube dislodgement (n = 9), development of granulation tissue (n = 11), decubitus ulcer (n = 5), and infection (n = 3). Patient/parents satisfaction (appraisal scale 1-3) and improvement of quality of life achieved statistical significance for both (P b .001).

Conclusions: Since button cecostomy and ACE were introduced in our institution as a management option, the treatment of fecal incontinence and intractable constipation significantly improved in terms of efficacy and patient compliance and also resulted in greater patient and parent satisfaction.
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Key Words: Cecostomy; Antegrade colonic enema; Laparoscopy; Fecal incontinence; Spina bifida