Halleran Devin R, Vilanova-Sanchez Alejandra, Rentea Rebecca M, Vriesman Mana H, Maloof Tassiana, Lu Peter L, Onwuka Amanda, Weaver Laura, Vaz Karla Kh, Yacob Desale, Di Lorenzo Carlo, Levitt Marc A, Wood Richard J
Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH.
Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH.
J Pediatr Surg. 2019 Jan;54(1):123-128. doi: 10.1016/j.jpedsurg.2018.10.008. Epub 2018 Oct 5.
Appendicostomy and cecostomy are two approaches for antegrade enema access for children with severe constipation or fecal incontinence as adjuncts to a mechanical bowel management program. Each technique is associated with a unique set of complications. The purpose of our study was to report the rates of various complications associated with antegrade enema access techniques to help guide which option a clinician offers to their patients.
We reviewed all patients in our Center who received an appendicostomy or cecostomy from 2014 to 2017 who were participants in our bowel management program.
204 patients underwent an antegrade access procedure (150 appendicostomies and 54 cecostomies). Skin-level leakage (3% vs. 22%) and wound infections (7% vs. 28%) occurred less frequently in patients with appendicostomy compared to cecostomy. Nineteen (13%) appendicostomies required revision for stenosis, 4 (3%) for mucosal prolapse, and 1 (1%) for leakage. The rates of stenosis (33 vs. 12%) and wound infection (13 vs. 6%) were higher in patients who received a neoappendicostomy compared to an in situ appendicostomy. Intervention was needed in 19 (35%) cecostomy patients, 15 (28%) for an inability to flush or a dislodged tube, and 5 for major complications including intraperitoneal spillage in 4 (7%) and 1 (2%) for a tube misplaced in the ileum, all occurring in patients with a percutaneously placed cecostomy. One appendicostomy (1%) patient required laparoscopic revision after the appendicostomy detached from the skin.
Patients had a lower rate of minor and major complications after appendicostomy compared to cecostomy. The unique complication profile of each technique should be considered for patients needing these procedures as an adjunct to their care for constipation or fecal incontinence.
Retrospective comparative study.
Level III.
阑尾造口术和盲肠造口术是为患有严重便秘或大便失禁的儿童建立顺行灌肠通道的两种方法，作为机械性肠道管理计划的辅助手段。每种技术都伴有一系列独特的并发症。我们研究的目的是报告与顺行灌肠通道技术相关的各种并发症的发生率，以帮助指导临床医生为患者提供哪种选择。
我们回顾了2014年至2017年在我们中心接受阑尾造口术或盲肠造口术且参与我们肠道管理计划的所有患者。
204例患者接受了顺行造口术（150例阑尾造口术和54例盲肠造口术）。与盲肠造口术相比，阑尾造口术患者的皮肤层面渗漏（3%对22%）和伤口感染（7%对28%）发生率较低。19例（13%）阑尾造口术因狭窄需要修复，4例（3%）因黏膜脱垂需要修复，1例（1%）因渗漏需要修复。与原位阑尾造口术相比，接受新阑尾造口术的患者狭窄发生率（33%对12%）和伤口感染发生率（13%对6%）更高。19例（35%）盲肠造口术患者需要干预，15例（28%）因无法冲洗或导管移位，5例因严重并发症，包括4例（7%）腹腔内渗漏和1例（2%）导管误置于回肠，所有这些均发生在经皮放置盲肠造口术的患者中。1例（1%）阑尾造口术患者在阑尾造口与皮肤分离后需要腹腔镜修复。
与盲肠造口术相比，阑尾造口术患者发生轻微和严重并发症的几率较低。对于需要这些手术作为便秘或大便失禁治疗辅助手段的患者，应考虑每种技术独特的并发症情况。
回顾性比较研究。
三级。
