Shawn Brophy1, Kelly Brennan1, Emily Woodgate1, Bridget Pinaud1, Elizabeth McLaughlin2, Joanne Gillespie2, Zubin Grover3, Christopher Blackmore1, Rodrigo Lp Romao4. 1. IWK Health, Dalhousie University, Division of Pediatric General and Thoracic Surgery, Department of Surgery, 5980 University Avenue, P.O. Box 9700, Halifax, Nova Scotia B3K 6R8, Canada. 2. IWK Health, Pediatric Health Psychology Service, Halifax, Nova Scotia, Canada. 3. IWK Health, Dalhousie University, Division of Pediatric Gastroenterology, Department of Pediatrics, Halifax, Nova Scotia, Canada. 4. IWK Health, Dalhousie University, Division of Pediatric General and Thoracic Surgery, Department of Surgery, 5980 University Avenue, P.O. Box 9700, Halifax, Nova Scotia B3K 6R8, Canada; IWK Health, Dalhousie University, Division of Pediatric Urology, Department of Urology, Halifax, Nova Scotia, Canada. Electronic address: rodrigo.romao@dal.ca.
Abstract
BACKGROUND: We compared patient- and family-reported overall and stool-related quality of life (QoL) before and after an antegrade continence enema (ACE) procedure (cecostomy tube insertion) for refractory chronic constipation or fecal incontinence (CCFI). We hypothesized that patients with functional diagnoses experience similar improvements in QoL compared to those with organic diagnoses. METHODS: This is a cross-sectional study of patients undergoing cecostomy tube insertion for CCFI at a tertiary pediatric hospital from 2012 to 2019. Patients and/or primary caregivers completed validated stooling and overall QoL surveys based on three time points: before surgery, three months after surgery, and at the time of survey / date of last follow-up. Repeated measures analyses compared scores over time between subjects and within the diagnostic groups. RESULTS: The response rate was 65% (22/34 patients, 12 organic and 10 functional diagnoses). Mean age was 8.3 years and 32% of the participants were female. Organic diagnoses were: spina bifida (6), anorectal malformation (5), and Hirschsprung Disease (1). There was substantial improvement in stool-related and overall QoL at three months post-ACE procedure (both p<0.001) for all patients; both scores continued to improve significantly until the date of last follow-up (median 4.1 years, IQR 2.3-5.6, p<0.001). There was no statistically significant difference in scores between patients with organic and functional diagnoses. CONCLUSIONS: Caregivers perceive a significant, sustainable improvement in stooling habits and QoL following ACE therapy. The improvement is comparable between patients with a functional diagnosis and those with an underlying organic reason for their CCFI.
BACKGROUND: We compared patient- and family-reported overall and stool-related quality of life (QoL) before and after an antegrade continence enema (ACE) procedure (cecostomy tube insertion) for refractory chronic constipation or fecal incontinence (CCFI). We hypothesized that patients with functional diagnoses experience similar improvements in QoL compared to those with organic diagnoses. METHODS: This is a cross-sectional study of patients undergoing cecostomy tube insertion for CCFI at a tertiary pediatric hospital from 2012 to 2019. Patients and/or primary caregivers completed validated stooling and overall QoL surveys based on three time points: before surgery, three months after surgery, and at the time of survey / date of last follow-up. Repeated measures analyses compared scores over time between subjects and within the diagnostic groups. RESULTS: The response rate was 65% (22/34 patients, 12 organic and 10 functional diagnoses). Mean age was 8.3 years and 32% of the participants were female. Organic diagnoses were: spina bifida (6), anorectal malformation (5), and Hirschsprung Disease (1). There was substantial improvement in stool-related and overall QoL at three months post-ACE procedure (both p<0.001) for all patients; both scores continued to improve significantly until the date of last follow-up (median 4.1 years, IQR 2.3-5.6, p<0.001). There was no statistically significant difference in scores between patients with organic and functional diagnoses. CONCLUSIONS: Caregivers perceive a significant, sustainable improvement in stooling habits and QoL following ACE therapy. The improvement is comparable between patients with a functional diagnosis and those with an underlying organic reason for their CCFI.
Authors: Marina L Reppucci; Margo M Nolan; Emily Cooper; Lea A Wehrli; Julie Schletker; Jill Ketzer; Alberto Peña; Andrea Bischoff; Luis De la Torre Journal: Pediatr Surg Int Date: 2022-09-15 Impact factor: 2.003