A comparison of Malone appendicostomy and cecostomy for antegrade access as adjuncts to a bowel management program for patients with functional constipation or fecal incontinence

Halleran, Devin R.; Vilanova-Sánchez, Alejandra; Rentea, Rebecca M.; Vriesman, Mana H.; Maloof, Tassiana; Lu, Peter L.; Onwuka, Amanda; Weaver, Laura; Vaz, Karla; Yacob, Desale; Lorenzo, Carlo Di; Levitt, Marc A.; Wood, Richard J.

doi:10.1016/j.jpedsurg.2018.10.008

Cited by 36 publications

(17 citation statements)

References 20 publications

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“…Several recent studies have reviewed the complication and reoperation rate of each procedure. 4,6,7 However, minimal literature exists on the effect of hospital admissions before and after surgery. Therefore, we hypothesized that patients that have underwent an ACE procedure would have decreased hospital admissions for constipation in the postoperative setting.…”

Section: Introductionmentioning

confidence: 99%

Reducing Constipation-Related Admissions: The Effectiveness of Antegrade Continence Enema Procedures in Children

Esparaz

Waters

Mathis

et al. 2021

The American Surgeon

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Introduction Constipation in pediatrics remains a common problem. Antegrade continence enema (ACE) procedures have been shown to decrease the distress of daily therapy. Patients are able to administer more aggressive washouts in the outpatient setting. Therefore, we hypothesize that patients following an ACE procedure would have reduced admissions for constipation. Methods Patients who underwent an ACE procedure at a large children’s hospital from 2015 to 2018 were included. Demographics, diagnosis, procedure, and preoperative/postoperative hospital admissions were analyzed. Results Forty-eight patients were included in the study. Over half were diagnosed with idiopathic constipation. Majority of patients underwent an appendicostomy (88%, n = 42). Preoperatively, 26 patients were admitted for a combined total of 63 times for constipation. Postoperatively, 4 patients were admitted for a total of 5 visits ( P = .021). Twenty-eight patients required a nonscheduled appendicostomy tube replacement. Conclusion This study demonstrates ACE procedures can improve constipation-related symptoms in children and are associated with decrease hospital admissions.

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Section: Introductionmentioning

confidence: 99%

Reducing Constipation-Related Admissions: The Effectiveness of Antegrade Continence Enema Procedures in Children

Esparaz

Waters

Mathis

et al. 2021

The American Surgeon

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“…Patient satisfaction, quality of life improvement, and continence rates were reported to be similar in both groups of patients [ 16 , 17 ]. However, Halleran et al reported that a cecostomy had less promising results as compared to a Malone appendicostomy in regard to leakage (22% vs. 3%), wound infections (28% vs. 7%), and the need for additional interventions (35%) for inability to flush, tube dislodgement, or major complications such as intraperitoneal spillage and tube misplacement in the ileum [ 18 ]. Cecostomy has also been shown to be associated with a higher rate of postoperative abdominal pain (54% vs. 14%) [ 19 ].…”

Section: Antegrade Continence Enemasmentioning

confidence: 99%

Pediatric Bowel Management Options and Organizational Aspects

et al. 2023

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A bowel management program (BMP) to treat fecal incontinence and severe constipation is utilized for patients with anorectal malformations, Hirschsprung disease, spinal anomalies, and functional constipation, decreasing the rate of emergency department visits, and hospital admissions. This review is part of a manuscript series and focuses on updates in the use of antegrade flushes for bowel management, as well as organizational aspects, collaborative approach, telemedicine, the importance of family education, and one-year outcomes of the bowel management program. Implementation of a multidisciplinary program involving physicians, nurses, advanced practice providers, coordinators, psychologists, and social workers leads to rapid center growth and enhances surgical referrals. Education of the families is crucial for postoperative outcomes, prevention, and early detection of complications, especially Hirschsprung-associated enterocolitis. Telemedicine can be proposed to patients with a defined anatomy and is associated with high parent satisfaction and decreased patient stress in comparison to in-person visits. The BMP has proved to be effective in all groups of colorectal patients at a 1- and 2-year follow-up with social continence achieved in 70–72% and 78% of patients, respectively, and an improvement in the patients’ quality of life. A transitional care to adult program is essential to maintain the same quality of care, and continuity of care and to achieve desired long-term outcomes as the patient reaches adult age.

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“…Complications common to all approaches include leakage at the skin and skin infection. Both carry equivalent likelihood of continence, and outcomes surrounding superiority of either are mixed [100,101].…”

Section: Cecostomymentioning

confidence: 99%

Pediatric Colorectal Disorders

Teeple

Azarow

2021

The ASCRS Textbook of Colon and Rectal Surgery

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The major principle of operative therapy for Hirschsprung's disease is to bring ganglionated bowel to within 1 cm of the dentate line.• The ideal surgical treatment of a duplication depends on length and location of duplication, age of child, and relationship to surrounding structures with complete excision being the goal, though not always possible. • Constipation and fecal incontinence need a full history and physical examination but are managed often successfully by medical management. • Anorectal malformations often occur with other congenital defects and a mainstay for surgery is an ano rectoplasty.

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A comparison of Malone appendicostomy and cecostomy for antegrade access as adjuncts to a bowel management program for patients with functional constipation or fecal incontinence

Cited by 36 publications

References 20 publications

Reducing Constipation-Related Admissions: The Effectiveness of Antegrade Continence Enema Procedures in Children

Reducing Constipation-Related Admissions: The Effectiveness of Antegrade Continence Enema Procedures in Children

Pediatric Bowel Management Options and Organizational Aspects

Pediatric Colorectal Disorders

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