Laparoscopic-assisted percutaneous endoscopic cecostomy in children with defecation disorders (with video).

Background: The antegrade continence enema (ACE) procedure has been widely used in the management of children with defecation disorders. The ACE procedure has undergone many technical modifications. We developed a safe and minimally invasive technique, the laparoscopic-assisted percutaneous endoscopic cecostomy (LAPEC).

Objective: To compare LAPEC to laparoscopic cecostomy in terms of operative time, hospital length of stay, and procedure-related morbidity.

Design: Retrospective review of children undergoing the ACE procedure.

Setting: Two tertiary-care centers.

Patients: This study involved children with defecation disorders.

Intervention: The ACE procedure.

Main Outcome Measurements: Procedure complications, length of stay, and operative time.

Results: Fifty patients underwent LAPEC, and 15 underwent laparoscopic cecostomy. Of the LAPEC patients, 70% were male, with mean age 12 ± 4.2 years, mean operative time 100.1 ± 16.6 minutes, and mean length of stay 3.4 ± 1.4 days. Of the laparoscopic cecostomy patients, 56% were male, with mean age 10.5 ± 4 years, mean operative time 100.8 ± 19.1 minutes, and mean length of stay 3.8 ± 1.6 days. There was no statistical difference between the 2 groups. The single intraoperative complication during LAPEC was a cecal hematoma. Postoperative complications after LAPEC included 6 patients with low-grade fever, 3 patients with tube dislodgement (2 treated by repeat LAPEC and the other by open surgery), and 2 patients with skin breakdown. Of the 50 LAPEC patients and their families, 48 were satisfied with the outcome.

Limitations: Retrospective study.

Conclusion: LAPEC is a safe, minimally invasive procedure for cecostomy placement in children with refractory constipation or fecal incontinence.