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At least 307 records · Page 17Linked to original sources
PubMed1999

Y-appendicoplasty: a technique to minimize stomal complications in antegrade continence enema.

PURPOSE: The antegrade continence enema (ACE) is an effective method of treatment of fecal incontinence and constipation. However, the original procedure described is not easy to perform and is associated with a high complication rate, especially stomal stenosis-necrosis (55%). Even with introduction of orthotopic appendicostomy, composite series still report an incidence of 30% with stomal problems. The authors report a virtually complication-free simple modification, the Y-appendicoplasty. METHODS: The base of the appendix is imbricated into cecum by 2 successive rows of interrupted seromuscular stitches. A small Y-shaped incision is made on the abdominal wall at McBurney's point, and 3 triangular skin flaps are raised. The appendix is brought out of the skin incision. The tip is excised, and 3 vertical cuts are made 120 degrees apart. The 3 appendiceal flaps thus created are interdigitated with the skin flaps using interrupted sutures. RESULTS: Twelve children underwent Y-appendicoplasty and orthotopic appendicostomy. Mean operating time was 1 hour. None experienced stomal complications that required intervention. Control of fecal continence with ACE ranged from excellent to good. CONCLUSION: Y-appendicoplasty and orthotopic appendicostomy minimizes complications for ACE and is easy to perform.

Appendix↗
PubMed2003

Long-term results for Malone antegrade continence enema for adults with neurogenic bowel disease.

OBJECTIVES: To determine the long-term outcomes from the Malone antegrade continence enema (ACE) procedure in adult neurogenic patients. METHODS: A retrospective review of adult patients who underwent the ACE procedure for neurogenic bowel was done. Patients were studied if they had follow-up of greater than 4 years. We compared pre-ACE and post-ACE toileting times, bowel continence status, and complications, and elicited patient subjective satisfaction with their quality of life. RESULTS: Six patients were available for study. Mean age was 35 years with a mean follow-up of 4.5 years. Urinary diversion was done in 5 patients. Pre-ACE toileting time was 190 +/- 45 minutes versus post-ACE toileting time of 28 +/- 20 minutes (P <0.001). Four of six patients pre-ACE were incontinent of stool per rectum compared with 1 of these 4 patients post-ACE (P = 0.03). Five patients were continent of stool per ACE stoma. Four patients (67%) had complications. Three of five patients (60%) who underwent synchronous urinary diversion required postoperative re-exploration. Five patients (83%) were satisfied with their outcome and rated their quality of life higher after the ACE procedure compared with pre-ACE. CONCLUSIONS: The ACE procedure is effective in the long-term management of adult neurogenic bowel. The complication and re-exploration rates are high. Patients must be properly selected to determine appropriate motivation.

Adult↗
PubMed2003

Durability of the Malone antegrade continence enema in pregnancy.

The Malone antegrade continence enema (MACE) is a therapeutic option to treat chronic constipation and fecal incontinence in patients with neurogenic bowel. Previous reports have described the short-term success of this procedure, but no report has described the durability of the procedure during pregnancy. We present the case of a spinal cord injury patient who underwent an uncomplicated pregnancy after a MACE procedure with no stomal catheterization difficulties or leakage during or after the pregnancy.

Adult↗
PubMed1998

Cecoappendicovesicostomy: conduit-lengthening technique for use in continent urinary reconstruction.

OBJECTIVES: To describe a conduit-lengthening technique for use in continent cutaneous appendicovesicostomy (Mitrofanoff procedure). METHODS: Fifteen consecutive patients (4 male, 11 female) with a mean age of 14.2 years underwent tubularized cecal augmentation as a means to lengthen the catheterizable conduit while performing continent cutaneous appendicovesicostomy. RESULTS: All patients successfully underwent appendiceal lengthening by tubularizing the cecum, thus creating a continent cutaneous cecoappendicovesicostomy. With a mean follow-up of 18.7 months, all patients have a working catheterizable conduit. One case of stomal stenosis occurred, producing a 6.7% conduit-related complication rate. CONCLUSIONS: Cecoappendicovesicostomy is a safe and useful means of conduit lengthening for patients undergoing continent cutaneous appendicovesicostomy (Mitrofanoff procedure).

Adolescent↗
PubMed1997

The value of the MACE (Malone antegrade colonic enema) procedure in adult patients.

BACKGROUND: We report our experience with the Malone antegrade colonic enema (MACE) procedure in adult patients suffering from urinary incontinence and intractable constipation with or without fecal soiling. STUDY DESIGN: Since June 1990, the MACE procedure was initiated in 4 female and 12 male patients 14-54 years old (mean age, 29.9 years) with different pathologic conditions (myelodysplasia, n = 7; anorectal anomaly, n = 3; spinal cord lesion, n = 4; neuropathic disease of unclear cause, n = 2). Three surgical techniques were used: reversed and in situ appendix and tapered ileum). Complex simultaneous urologic continence procedures were performed in nine patients. Two patients had undergone previous operations in the lower urinary tract. RESULTS: After 6.6 years of followup (average, 41.7 months), eight patients (50%) were still using the MACE successfully. They were completely clean day and night and were relieved of symptoms of constipation. Eleven complications related to the MACE procedure occurred in seven patients (44%). Eight patients abandoned the procedure for various reasons. The failure rate was higher in chronically constipated patients without fecal soiling. CONCLUSIONS: The MACE procedure is associated with a high failure rate when used in adults, but it may be possible to identify a subgroup of patients in whom the procedure could be beneficial. Success would depend on overcoming technical problems and difficulties with patient compliance.

Adolescent↗
PubMed1998

The Malone antegrade continence enema procedure in the management of patients with spina bifida.

BACKGROUND: In patients with spina bifida, traditional bowel management programs such as suppositories, retrograde enemas, and manual disimpaction have been largely unsatisfactory. The Malone antegrade continence enema (ACE) procedure has largely changed our approach to bowel management in this patient group. STUDY DESIGN: Over a 3-year period between January 1994 and January 1997, 27 patients with spina bifida underwent the Malone ACE procedure at our institutions. At the time of their ACE procedure, four patients underwent simultaneous continent urinary diversion and three had simultaneous small-bowel bladder augmentation. All the patients were evaluated for 9 months or more after their procedure, and 10 of the patients have been followed for more than 2 years. RESULTS: Postoperatively, predictable bowel control and continence were achieved in 19 of the 27 patients, but 6 had some rectal soiling requiring a sanitary pad. All patients were out of diapers and none reported stomal leakage. Eighteen of the 27 patients were able to manage independently and 9 required assistance. Two patients had stopped using their ACE stoma despite good technical results. The appendix was used as a catheterizable stoma in 15 of the 27 patients. The appendix was not available in 12 patients, so a tubularized cecal flap was used in 9 and a small-bowel neoappendix was created in 3. Complications included stomal stenosis in 5 patients, cecal-flap necrosis in 1, and stomal granulations in 3. CONCLUSIONS: We believe that the ACE procedure provides reliable colonic emptying and avoids fecal soiling in the majority of individuals, and we find it widely and enthusiastically accepted by patients with spina bifida.

Adolescent↗
PubMed1998

Tube caecostomy to protect rectal anastomoses.

BACKGROUND: Low rectal anastomoses are associated with a substantial risk of anastomotic leakage. Tube caecostomy offers a potentially simple method of anastomotic protection. METHODS: Some 226 patients undergoing restorative rectal resection with on-table colonic lavage and tube caecostomy over an 11-year period were reviewed. Endpoints selected included clinical anastomotic leakage, requirement for a subsequent formal stoma and complications of tube caecostomy. RESULTS: Overall, clinical anastomotic leakage occurred in 25 patients with a caecostomy (11.1 per cent). All leaks were noted among patients in whom caecostomy protection had been used after low anterior resection, giving a leak rate of 14.9 per cent (25 of 168) for this group of whom 17 (10.1 per cent) required reoperation and a formal stoma, and five (3.0 per cent) died. Complications of caecostomy or prolonged drainage after tube removal occurred in ten (4.4 per cent) and 15 (6.6 per cent) patients respectively. There were two cases of life-threatening invasive infection. CONCLUSION: Tube caecostomy provides inadequate protection of rectal anastomoses; complications are common and may be life threatening.

Anastomosis, Surgical↗
PubMed2002

Scintigraphic assessment of antegrade colonic irrigation through an appendicostomy or a neoappendicostomy.

BACKGROUND: The aim of this study was to evaluate large bowel transport following antegrade colonic irrigation with a new scintigraphic technique. METHODS: Ten patients (eight with severe constipation, two with faecal incontinence; median age 47 (range 41-66) years) treated with antegrade colonic irrigation took 111In-labelled polystyrene pellets to label the bowel contents. 99mTc-labelled diethylenetriamine penta-acetate was mixed with the irrigation fluid to map its distribution within the large bowel. Scintigraphy was performed before and after a standardized irrigation procedure. The large bowel was divided into four segments. Assuming ordered evacuation of the large bowel, the contribution of each colonic segment to total evacuation was expressed as a percentage of original segmental count. The segmental contributions were added to reach a total defaecation score (range 0-400). RESULTS: The median defaecation score was 350, corresponding to complete emptying of the rectosigmoid, descending colon, transverse colon, and half of the caecum and ascending colon. The retained irrigation fluid was located throughout the large bowel. Back-flow to the ileum was observed in four patients. CONCLUSION: This study used a new scintigraphic technique to assess large bowel transport following antegrade colonic irrigation. Antegrade colonic irrigation induces highly effective emptying even in patients with severe constipation.

Adolescent↗
PubMed2003

Gastrointestinal interventions--emphasis on children.

Although the fundamental principles of interventional and minimally invasive image-guided techniques are the same in children as in adults, nonetheless the spectrum of diseases, the pediatric approach, and the devices used differ significantly from those in adults. The following is a general overview of image-guided gastrointestinal interventions in children and neonates, with emphasis on those aspects peculiar to children. Many of the facets and tips have been learned the hard way over the years, in a busy pediatric practice. Although there are several potential ways to do some of these procedures, the description below reflects our practice and experience. In general terms, minimizing radiation dose is a significant responsibility for the pediatric interventionalist. Reducing the number of exposures, reliance on last image hold, low-dose pulse fluoroscopy, and tight coning are all important. Protection for the radiologist is equally important, but sometimes difficult to achieve, given the small size of many of the patients.

Cecostomy↗
PubMed2002

The left Monti-Malone procedure: Preliminary results in seven cases.

BACKGROUND/PURPOSE: The management of children who have congenital intestinal dysfunction and continuous feces soiling has been improved significantly by the Malone continent caecostomy. When the appendix is not available, the Monti tube represents a good alternative to create a catheterizable conduit. The authors report here 7 cases of left continent colonic access (left Monti-Malone). METHODS: From July 1999 to January 2001 7 patients have been operated on in our unit: 6 spina bifida, 1 cloacal exstrophy. Technically, a ring of descending colon of 1.5 to 2 cm width is isolated with its meso, the Monti's tube fashioned, and implanted into the left colon according to the Malone's technique. Antegrade bowel washouts start 3 weeks after surgery with standard saline (200 to 500 mL) +/- phosphate enemas. A period of 1 to 3 months is needed to adjust to the right enema regimen to get a satisfactory result. RESULTS: The follow-up range is 18 months to 1.5 months. One patient is excluded. The duration of the enemas varies between 10 and 30 minutes, and the number of enemas varies from 1 to every 2 or 3 days. Five children are clean and perform their antegrade enemas after dinner to avoid the embarrassment of post enema leakages. CONCLUSION: Although it is a short series with a short follow-up, the first results collected show a significant shortening of the duration of the enema with excellent outcomes in terms of continence.

Adolescent↗
PubMed2002

Fecal incontinence in anorectal malformations, neuropathy, and miscellaneous conditions.

In the majority cases, fecal soiling in children is functional and usually associated with severe constipation. Fortunately, functional soiling is a self-limiting problem and usually disappears at puberty. Organic fecal incontinence is a consequence of congenital malformations affecting the anorectum, anal sphincters, or the spinal cord. Inability to control bowel function may be permanent, as in patients with myelodysplasia; self-limiting, as in patients who have fecal soiling after a pull-through operation for Hirschsprung's disease; or partial, as in many patients who have undergone repair of an anorectal malformation. The purpose of this report is to review the etiology, long-term outcome, and evolution of the management of different types of organic fecal incontinence in children. Knowledge of the pathophysiology of fecal incontinence has accumulated during recent decades, and this provides the basis of modern treatment modalities that have revolutionized treatment so that today most patients can be provided total or at least social continence from early childhood.

Anal Canal↗
PubMed2002

Treatment of neuropathic urinary and faecal incontinence.

The author presents 14 children after meningomyelocoele repair with faecal and urinary incontinence, aged from 6 to 17 years who have undergone the MACE procedure. MACE with synchronous Mitrofanoff continent stoma creation was performed in one child with severe stenosis of the urethra. MACE with simultaneous bladder augmentation was used in 10 patients. 5 of them underwent colocystoplasty, 3 had ileocystoplasty and 2 ureterocystoplasty. Of these 10 children, three have additionally undergone the Mitrofanoff procedure. Patients' follow-up ranged from six months to two years. Three children had trouble with the MACE stoma because of its stenosis. One of them required revision of the stoma. All patients became clean and dry, and this operation improved not only their quality of life, but also their independence.

Adolescent↗
PubMed2002

Quantification of digesta flow into the caeca.

1. A caecal intubation technique was developed to determine the amount of digesta that enters the caeca of fed and feed-deprived chickens. 2. Dry matter intakes per day for control and caecostomised chickens were not significantly different. 3. For fed and feed-deprived roosters, water intake was significantly increased by caecostomy in control birds and was significantly increased by feeding. 4. Amount of caecal dry matter excretion was significantly increased by feeding, but no difference in caecal water excretion was observed. 5. The ratio of caecal excretion (caecal/total excretion) of dry matter and water tended to decrease in response to feeding. 6. It is concluded that dry matter entry into the caeca represents 18% or 25% of the total dry matter excretion in fed or feed-deprived birds, respectively. Corresponding values for water entry are 17 and 26%. Therefore, the caeca play an important role in water balance.

Animal Feed↗
PubMed1998

Malone antegrade continence enemas for autonomic dysreflexia secondary to neurogenic bowel.

A 42-year-old man with T-4 ASIA B thoracic paraplegia presented with chronic constipation, fecal incontinence, and bowel-related autonomic dysreflexia (AD) refractory to conservative bowel program. His usual toileting time lasted one to five hours. Antegrade continence enemas (ACE) were performed. The ACE technique, which requires creating a continent catheterizable appendicocecostomy, is described. Postoperatively, a daily enema was given through the stoma. The patient's toileting time was reduced to 20 minutes and his AD resolved. The role of the ACE is discussed in adult spinal cord injury (SCI).

Adult↗
PubMed2006

Appendicostomy stomas and antegrade colonic irrigation after laparoscopic antegrade continence enema.

BACKGROUND: Children with spina bifida, high anorectal anomalies, or neuronal intestinal dysplasia who are treated with a laparoscopic antegrade continence enema to achieve a socially acceptable level of fecal continence sometimes have problems with the stoma and its catheterization. The goal of this study was to determine the nature and incidence of these problems, and their relationship to the underlying condition. MATERIALS AND METHODS: A retrospective review of the hospital case notes of 74 consecutive patients who had a laparoscopic antegrade continence enema was undertaken. RESULTS: The laparoscopic antegrade continence enema procedure is well tolerated but is associated with a variety of usually minor complications including stomal stenosis, leakage, peristomal infection, granulation tissue overgrowth, mucosal prolapse, abdominal discomfort during irrigation, appendiceal false passage, and ineffective irrigation. Surgical revision of the stoma was required in 19% of the cases in this study, usually because of stenosis and skin overgrowth. Ongoing problems achieving colonic emptying were most likely to occur in patients with an anorectal malformation. CONCLUSION: Overall, the laparoscopic antegrade continence enema provides an effective method of facilitating emptying of the bowel. However, it has a high incidence of minor troublesome problems, with stenosis and skin overgrowth of the stoma being the most common. Younger children tend to have more complications and difficulty performing effective irrigation. Children with anorectal malformations were more likely to require surgical revision of the stoma, and often needed ongoing manual evacuation and bowel washouts despite the laparoscopic antegrade continence enema.

Adolescent↗