Lawal Taiwo A, Rangel Shawn J, Bischoff Andrea, Peña Alberto, Levitt Marc A
Division of Pediatric Surgery, Department of Surgery, Colorectal Center for Children, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio 45229, USA.
J Laparoendosc Adv Surg Tech A. 2011 Jun;21(5):455-9. doi: 10.1089/lap.2010.0359. Epub 2011 Mar 2.
The antegrade continence enema procedure offers convenient enema administration for patients with fecal incontinence and can be performed by a minimally invasive approach that provides shorter hospital stay, less analgesia requirement, and better cosmesis. We present our experience using this approach for fecal incontinence patients and technical modifications to reduce complications.
Following successful management of fecal incontinence through bowel management using a daily rectal enema, 44 patients underwent a laparoscopic-assisted Malone appendicostomy procedure. We reviewed the diagnosis underlying the fecal incontinence, operative technique, duration of surgery, length of hospital stay, and postoperative complications.
The mean age at surgery was 8.6 ± 1.0 years. The diagnoses included anorectal malformations (31), idiopathic constipation (6), Hirschsprung disease (3), and others (4). All the patients underwent a V-V umbilico-appendicoplasty. The cecum was plicated around the base of the appendix in 34 patients (77%); this step was omitted in 10 (23%). The median follow-up was 21 months (range: 3-51 months). Twelve complications were recorded in 9 patients (20.5%)--leakage from the stoma in 1 (2.3%), stomal stenosis in 5 (11.4%), and a combination of both in 3 (6.8%)--with an overall stricture rate of 18.2% (8/44) and leakage rate of 9.1% (4/44). Strictures were managed with minor operative revision. Plicating the cecum was associated with a lower leakage rate compared with the nonplicated group (0/34, 0% versus 4/10, 40%; P = .002). All patients were consistently clean between enemas following their antegrade continence enema procedure.
The umbilical appendicostomy provides a convenient and cosmetic location for enema administration. Cecal plication, which is feasible using a laparoscopic-assisted approach, significantly reduces the leakage rate. Stomal stenoses remains a problem, may be lessened by a V-to-V umbilical to appendix anastomosis, and are easily fixed with a revision.
顺行性节制灌肠术为大便失禁患者提供了便捷的灌肠方式，可通过微创方法实施，具有住院时间短、镇痛需求少及美容效果好等优点。我们介绍了使用该方法治疗大便失禁患者的经验以及为减少并发症所做的技术改进。
在通过每日直肠灌肠进行肠道管理成功治疗大便失禁后，44例患者接受了腹腔镜辅助的马龙氏阑尾造口术。我们回顾了大便失禁的潜在诊断、手术技术、手术时长、住院时间及术后并发症。
手术时的平均年龄为8.6±1.0岁。诊断包括肛门直肠畸形（31例）、特发性便秘（6例）、先天性巨结肠（3例）及其他（4例）。所有患者均接受了V-V型脐部阑尾成形术。34例患者（77%）将盲肠围绕阑尾根部折叠；10例患者（23%）未进行此步骤。中位随访时间为21个月（范围：3 - 51个月）。9例患者（20.5%）出现12例并发症——1例（2.3%）造口渗漏，5例（11.4%）造口狭窄，3例（6.8%）两者皆有——总体狭窄率为18.2%（8/44），渗漏率为9.1%（4/44）。狭窄通过小型手术修正进行处理。与未折叠组相比，折叠盲肠的渗漏率更低（0/34，0%对4/10，40%；P = 0.002）。所有患者在接受顺行性节制灌肠术后，灌肠期间始终保持清洁。
脐部阑尾造口术为灌肠提供了便捷且美观的部位。使用腹腔镜辅助方法可行的盲肠折叠显著降低了渗漏率。造口狭窄仍然是一个问题，V-V型脐部至阑尾吻合术可能会减轻该问题，并且通过修正很容易解决。
