Shifra Koyfman1,2, Kristen Swartz2, Allan M Goldstein2,3, Kyle Staller4,5. 1. Division of Pediatric Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. 2. Department of Pediatric Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. 3. Center for Neurointestinal Health, Massachusetts General Hospital, Boston, MA, USA. 4. Center for Neurointestinal Health, Massachusetts General Hospital, Boston, MA, USA. kstaller@mgh.harvard.edu. 5. Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. kstaller@mgh.harvard.edu.
Abstract
OBJECTIVE: We evaluated the safety and efficacy of the laparoscopic-assisted percutaneous endoscopic cecostomy (LAPEC) procedure both in children and young adults, along with review of their pre-operative motility profiles, antegrade continence enema (ACE) regimen, and postoperative complications. METHODS: This retrospective review investigated 38 patients (32 children and 6 young adults) that underwent the LAPEC procedure. Primary outcomes evaluated were success versus failure of the procedure and post-operative complications. Success was defined as daily stool evacuation with minimal to no fecal incontinence per week. RESULTS: Mean follow up time was 25.8 ± 22.4 months. Indications for LAPEC included slow transit constipation or colonic neuropathy (n = 22), other types of constipation (n = 5), and a variety of congenital disorders (n = 11). The overall success rate was 95% (36/38 patients) with the two failures in children, both attributed to inability to use the tube due to underlying behavioral disorders or severe anxiety. Five patients above age 18 had leakage compared to 6 in the under age 18 group (83% vs. 19, P = 0.003). There were no other significant complications. CONCLUSION: LAPEC is a safe and effective means of addressing refractory constipation and fecal incontinence in children and young adults who have failed medical management with minimal post-operative complications.
OBJECTIVE: We evaluated the safety and efficacy of the laparoscopic-assisted percutaneous endoscopic cecostomy (LAPEC) procedure both in children and young adults, along with review of their pre-operative motility profiles, antegrade continence enema (ACE) regimen, and postoperative complications. METHODS: This retrospective review investigated 38 patients (32 children and 6 young adults) that underwent the LAPEC procedure. Primary outcomes evaluated were success versus failure of the procedure and post-operative complications. Success was defined as daily stool evacuation with minimal to no fecal incontinence per week. RESULTS: Mean follow up time was 25.8 ± 22.4 months. Indications for LAPEC included slow transit constipation or colonic neuropathy (n = 22), other types of constipation (n = 5), and a variety of congenital disorders (n = 11). The overall success rate was 95% (36/38 patients) with the two failures in children, both attributed to inability to use the tube due to underlying behavioral disorders or severe anxiety. Five patients above age 18 had leakage compared to 6 in the under age 18 group (83% vs. 19, P = 0.003). There were no other significant complications. CONCLUSION: LAPEC is a safe and effective means of addressing refractory constipation and fecal incontinence in children and young adults who have failed medical management with minimal post-operative complications.
Authors: Sebastian K King; Jonathan R Sutcliffe; Bridget R Southwell; Peter G Chait; John M Hutson Journal: J Pediatr Surg Date: 2005-12 Impact factor: 2.545
Authors: Nader N Youssef; Edward Barksdale Jr; Janet M Griffiths; Alejandro F Flores; Carlo Di Lorenzo Journal: J Pediatr Gastroenterol Nutr Date: 2002-04 Impact factor: 2.839
Authors: Sani Ziad Yamout; Philip L Glick; Yi-Horng Lee; Dean V Yacobucci; Stanley T Lau; Mauricio A Escobar; Michael G Caty Journal: Pediatr Surg Int Date: 2009-10-07 Impact factor: 1.827
Authors: William E Whitehead; Lori Borrud; Patricia S Goode; Susan Meikle; Elizabeth R Mueller; Ashok Tuteja; Alison Weidner; Milena Weinstein; Wen Ye Journal: Gastroenterology Date: 2009-05-04 Impact factor: 22.682