Laparoscopic-assisted percutaneous endoscopic cecostomy in children with defecation disorders (with video) - 12/08/11
Reprint requests: Leonel Rodriguez, MD, MS, Center for Motility and Functional Gastrointestinal Disorders, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115Résumé |
Background |
The antegrade continence enema (ACE) procedure has been widely used in the management of children with defecation disorders. The ACE procedure has undergone many technical modifications. We developed a safe and minimally invasive technique, the laparoscopic-assisted percutaneous endoscopic cecostomy (LAPEC).
Objective |
To compare LAPEC to laparoscopic cecostomy in terms of operative time, hospital length of stay, and procedure-related morbidity.
Design |
Retrospective review of children undergoing the ACE procedure.
Setting |
Two tertiary-care centers.
Patients |
This study involved children with defecation disorders.
Intervention |
The ACE procedure.
Main Outcome Measurements |
Procedure complications, length of stay, and operative time.
Results |
Fifty patients underwent LAPEC, and 15 underwent laparoscopic cecostomy. Of the LAPEC patients, 70% were male, with mean age 12 ± 4.2 years, mean operative time 100.1 ± 16.6 minutes, and mean length of stay 3.4 ± 1.4 days. Of the laparoscopic cecostomy patients, 56% were male, with mean age 10.5 ± 4 years, mean operative time 100.8 ± 19.1 minutes, and mean length of stay 3.8 ± 1.6 days. There was no statistical difference between the 2 groups. The single intraoperative complication during LAPEC was a cecal hematoma. Postoperative complications after LAPEC included 6 patients with low-grade fever, 3 patients with tube dislodgement (2 treated by repeat LAPEC and the other by open surgery), and 2 patients with skin breakdown. Of the 50 LAPEC patients and their families, 48 were satisfied with the outcome.
Limitations |
Retrospective study.
Conclusion |
LAPEC is a safe, minimally invasive procedure for cecostomy placement in children with refractory constipation or fecal incontinence.
Le texte complet de cet article est disponible en PDF.Abbreviations : ACE, LAPEC, PEC, PEG
Plan
| DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. |
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| If you would like to chat with an author of this article, you may contact Dr Rodriquez at Leonel.rodriguez@childrens.harvard.edu. |
Vol 73 - N° 1
P. 98-102 - janvier 2011 Retour au numéro
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