INTRODUCTION AND OBJECTIVE:We present perioperative outcomes of our single center experience with robotic assisted ACE channel creation for the treatment of chronic constipation refractory to medical therapy and compare it to the traditional open approach. We also demonstrate a step-by-step video presentation of the robotic approach for cecal flap ACE performed as part of a dual continence procedure.METHODS: A retrospective chart review of pediatric patients who underwent ACE channel creation between 2008-2019 was performed. We compared perioperative outcomes of the open versus robotic approach as seen in table 1.RESULTS: Of 28 patients, 15 were open and 13 robotic assisted. The etiology of neurogenic bowel and chronic constipation was spinal dysraphism in 93%, and cerebral palsy in 7% of the patients. 93% of patients underwent ACE channel creations in combination with one or more necessary procedures (e.g. 57% augmentation cystoplasty, 67% appendicovesicostomy, and 36% bladder neck reconstruction). In order to construct the ACE channel, a cecal flap was utilized in 36%, split appendix in 50%, full length appendix in 11%, and sigmoid colon in 3% of patients. Both approaches showed equivalent estimated blood loss (50 ml), median length of hospital stay (7 vs. 8 days, p[0.7) and time to return to regular diet (4 vs. 5 days, p[0.5) (table 1). The risk of Clavien-Dindo grade 3 or more complications (53.3 vs. 15.4%, p[0.04) and the rate of ACE channel stenosis (46.7% vs. 7.7%, p[0.02) were significantly higher in the open approach. The risk of ACE channel stenosis was significantly higher in patients with an appendix ACE channel (87.5% vs. 12.5%, p <0.05) compared to those with cecal flap ACE. 87% of ACE channels in the open group and 84.6% in the robotic group are still functional and utilized on last patient follow-up.CONCLUSIONS: In pediatric patients with constipation refractory to medical therapy, robotic assisted ACE channel creation is a safe and acceptable alternative with a significantly lower rate of channel stenosis and other Clavien grade 3 complications compared to the traditional open approach in our series. Cecal flaps are at a lower risk of channel stenosis than appendix.
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