Laparoscopic Cecostomy Placement for Antegrade Enema Access in the Pediatric Population.

Abstract

Aim: Use of the appendix for an antegrade continence enema (ACE) is not always possible. Various methods exist for creating cecostomy tubes, including percutaneous, endoscopic, or surgical placement. We describe our laparoscopic cecostomy technique and review short- and long-term outcomes.

Methods: Single institution retrospective review of children who underwent laparoscopic cecostomy placement from June 2016-June 2023. The cecum is secured to the abdominal wall with trans-fascial sutures and placement of an enterostomy button under direct vision. Half-volume flushes begin after 48 h; after two weeks, patients transition to full flushes. Demographic, intraoperative, and postoperative variables were analyzed.

Results: Forty patients were included [24 (60 %) female; 31 (77.5 %) Caucasian]. Twenty-one (52.5 %) had myelomeningocele, 15 (37.5 %) had an anorectal malformation and 4 (10 %) had functional constipation. Twenty-five (62.5 %) underwent laparoscopic cecostomy placement alone, while 15 (37.5 %) had it performed with another procedure. Median operative time was 1.12 (IQR 0:93-1.45) hours for isolated cecostomy placement, with median post-operative stay of 2.0 days (2.2-3.1) days. Post-operatively, one patient had severe withholding, ultimately requiring a diverting ileostomy. No other 30-day complications (surgical site infection, tube removal) were identified. One patient required revision four months post-op due to inadvertent placement in the sigmoid. At one-year follow-up, 11/36 (30.6 %) children noted granulation tissue, and 11 (30.6 %) noted superficial leakage. Two (6 %) patients had transitioned to oral laxatives.

Conclusion: Laparoscopic cecostomy tube placement is a safe and alternative method of developing ACE access that can be done concurrently with other procedures.