Laparoscopic Appendicostomy Low-Profile Balloon Button for Antegrade Enemas in Children.


eMediNexus    16 May 2018

A recent study published in the Journal of Laparoendoscopic & Advanced Surgical Techniques was based on the hypothesis that Malone appendicostomy, which requires daily cannulation and is susceptible to stenosis, when used with an indwelling low-profile balloon button tube inserted through the appendix into the cecum for antegrade enemas, is effective at managing constipation or fecal incontinence and is associated with a low rate of stenosis. This study included 35 children who underwent laparoscopic appendicostomy balloon button placement from January 2011 to April 2017, wherein postoperative complications were analyzed. It was noted that 88.5% patients underwent the operation for idiopathic constipation, 8.6% patients for anorectal malformation, and 2.9% for hypermobility. The results showed that the rate of open conversion was 3%. A full response was obtained in 68.6% patients; partial response in 25.7% patients, whereas 5.7% patients had no response. However, one patient developed an internal hernia requiring laparotomy, which was followed by a mucosal prolapse. Meanwhile, one patient developed a stricture noted at button change. On the other hand, 20% patients underwent reversal of their appendicostomy tube – five due to return of normal bowel function and two due to discomfort with flushes. It was inferred that laparoscopic appendicostomy with a balloon button tube is an effective means of addressing chronic constipation or fecal incontinence. Furthermore, it was stated that the stenosis rate associated with tube appendicostomy may be lower than that reported for Malone antegrade continence enema procedures.

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