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KMID : 1152420190250010001
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Advances in Pediatric Surgery
2019 Volume.25 No. 1 p.1 ~ p.6
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Feasibility and Early Outcomes of Continent Catheterizable Stomas Using Cecal/Colon and Ileum for Children with Fecal Incontinence as an Alternative to Appendicular Malone Antegrade Continence Enema
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Shankar Gowri
Solanki Shailesh
Jadhav Vinay
Babu M. Narendra
Ramesh S.
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Abstract
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Purpose: The introduction of Malone antegrade continence enema) in the management of children with fecal incontinence has brought remarkable improvement in patient care, Malone originally described appendix as a conduit and it has become widely accepted. However, surgeons are faced with situations where appendix is not available, the selection and creation of other conduit is always a challenge. We present our technique and experience with the use of alternative catheterizable conduits for antegrade continence enema (ACE).
Methods: Retrospective review of children who underwent ACE procedure in our institution from March 2009 to January 2014. The details retrieved: indication, reason for non availability of appendix, type of conduit, complications and patient's satisfaction.
Results: Five children were identified in whom the appendix was not available or suitable. In four children cecal/colon-based flap was used and in one child, ileal (Monti) segment was used to create a conduit. The mean follow-up was 3.2 years. All patients were satisfied with the procedure and no stenosis or loss of conduit was noted in the follow-up.
Conclusion: Continent catheterizable conduit for ACE can be accomplished with transverse tubularized intestinal segments and cecal/colonic flaps, with excellent outcome, irrespective of tissue used. Surgeon's preference and the patient's peculiar anatomy should determine the surgical technique to be used.
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KEYWORD
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Malone antegrade continence enema, Left-colon antegrade continence enema, Fecal incontinence
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