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.