Jonker Charlotte Anne Louise, Koppen Ilan, Benninga Marc A, Jong Justin R de, Gorter Ramon
Department of Pediatric Surgery, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands.
Department of Pediatric Gastroenterology and Nutrition, Amsterdam UMC Locatie AMC, Amsterdam, Noord-Holland, The Netherlands.
Eur J Pediatr Surg. 2025 Aug;35(4):286-294. doi: 10.1055/a-2511-9184. Epub 2025 Jan 9.
To assess the incidence and types of complications and patient-reported outcomes in pediatric patients with therapy-resistant constipation or fecal incontinence (FI) without constipation who underwent Chait Trapdoor™ cecostomy (CTC). The findings contribute to the discussion on selecting the optimal antegrade continence (ACE) procedure for this population.
A retrospective review was conducted on all pediatric patients with therapy-resistant constipation or FI without constipation who underwent a CTC procedure at our tertiary referral center between 2009 and 2023. Postoperative complications were classified using the Clavien-Madadi classification. At their most recent follow-up in 2023, patients reported satisfaction with their CTC.
The study included 62 children (median age 12 years [IQR 8-14; range 1-17], 42% male), with a median follow-up of 4 years (IQR 2-8, range 0-14). Underlying diagnoses were functional constipation ( = 39, 63%), spina bifida ( = 11, 18%), and anorectal malformations ( = 5, 8%). A total of 49/62 patients (79%) experienced 89 CTC-related complications. Minor complications (Clavien-Madadi I-II) affected 29 patients (47%) and most commonly included granulation. Major complications (Clavien-Madadi III-IV) requiring surgery occurred in 32% of patients. Despite these complications, 40/62 (65%) patients reported satisfaction with their CTC, as determined by partial or complete symptom resolution.
Although complications were common, 65% of the patients reported satisfaction with their CTC. These findings emphasize the need for thorough patient selection, informed counseling on potential risks, and individualized management strategies to enhance outcomes.
评估接受Chait活板门™盲肠造口术（CTC）的难治性便秘或无便秘的大便失禁（FI）儿科患者的并发症发生率、类型及患者报告的结局。这些发现有助于讨论为该人群选择最佳的顺行性节制（ACE）手术。
对2009年至2023年在我们三级转诊中心接受CTC手术的所有难治性便秘或无便秘的FI儿科患者进行回顾性研究。术后并发症采用Clavien-Madadi分类法进行分类。在2023年的最近一次随访中，患者报告了对其CTC的满意度。
该研究纳入了62名儿童（中位年龄12岁[四分位间距8 - 14岁；范围1 - 17岁]，42%为男性），中位随访时间为4年（四分位间距2 - 8年，范围0 - 14年）。潜在诊断为功能性便秘（n = 39，63%）、脊柱裂（n = 11，18%）和肛门直肠畸形（n = 5，8%）。共有49/62名患者（79%）发生了89例与CTC相关的并发症。轻微并发症（Clavien-Madadi I-II级）影响了29名患者（47%），最常见的是肉芽形成。需要手术的严重并发症（Clavien-Madadi III-IV级）发生在32%的患者中。尽管有这些并发症，但根据部分或完全症状缓解情况，40/62名（65%）患者报告对其CTC感到满意。
尽管并发症很常见，但65%的患者报告对其CTC感到满意。这些发现强调了进行全面的患者选择、就潜在风险提供充分咨询以及制定个体化管理策略以改善结局的必要性。
