Laparoscopic insertion of antegrade continence enema catheter: a technique enabling early postoperative usage.
ABSTRACT The Chait Trapdoor Caecostomy catheter was developed to allow the use of antegrade continence enemas without using the appendix. We describe a technique for its insertion under laparoscopic guidance.
Bowel is secured to the abdominal wall using nonabsorbable sutures. Technical details of the procedure are described.
Five children underwent the procedure. Four had a left-sided procedure and tolerated the procedure well without complications. They have good results with daily antegrade enemas. One child who had a cecostomy had postoperative abdominal distension. He has ongoing soiling and constipation, but has problems with compliance.
We have used the technique in a small number of patients, but results have been favorable. The sutures prevent the risk of the bowel segment slipping from the tube when distended with fluid, provide a good seal around the tube to avoid leakage, and keep a smooth alignment of bowel without angulation.
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ABSTRACT: To retrospectively evaluate experience with percutaneous cecostomies and their long-term outcomes. Between June 1994 and March 2009, 290 patients (mean age, 10.1 y) with fecal incontinence underwent percutaneous cecostomy tube placement and subsequent tube management. Technical success, procedural complications, and long-term follow-up until March 2012 were evaluated. A cecostomy was successfully placed in 284 patients (98%), and 257 of 280 patients (92%) underwent a successful exchange to a low-profile tube. A total of 1,431 routine exchanges to low-profile tubes were reviewed in 258 patients (mean, 1.6 ± 1.3 routine tube changes per 1,000 days). Eighty-five patients (29%) experienced one or more early problems after cecostomy, and 10 (3%) had major complications. In the total 463,507 tube-days, 938 late problems were noted: 917 (98%) minor and 22 (2%) major. Forty patients had the cecostomy catheter removed and 141 "graduated" to an adult health care facility. The percutaneous cecostomy procedure provides a safe management option for fecal incontinence in the pediatric population. Copyright © 2015 SIR. Published by Elsevier Inc. All rights reserved.Journal of vascular and interventional radiology: JVIR 12/2014; 26(2). DOI:10.1016/j.jvir.2014.10.015 · 2.15 Impact Factor
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ABSTRACT: Fecal incontinence is a frequent and debilitating condition that may result from a multitude of different causes. Treatment is often challenging and needs to be individualized. During the last several years, new technologies have been developed, and others are emerging from clinical trials to commercialization. Although their specific roles in the management of fecal incontinence have not yet been completely defined, surgeons have access to them and patients may request them. The purpose of this project is to put into perspective, for both the patient and the practitioner, the relative positions of new and emerging technologies in order to propose a treatment algorithm.Surgical Endoscopy 03/2014; 28(8). DOI:10.1007/s00464-014-3464-3 · 3.31 Impact Factor