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Antegrade continent enema procedures performed prior to starting school may improve functional stooling and quality of life

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Abstract

Purpose

A major research gap is determining the best age to perform an appendicostomy or cecostomy. This study hypothesizes that performance of appendicostomy/cecostomy prior to starting school (<6 years) would improve functional stooling and quality of life (QOL).

Methods

Patients who underwent appendicostomy/cecostomy for bowel management between 2003 and 2013 were retrospectively identified. Families were prospectively surveyed regarding current stooling habits (17 items) and a (7 item) pediatric QOL survey. Lower stooling survey scores represent better bowel control. Higher QOL scores indicated better quality. The primary outcome was to correlate age of appendicostomy/cecostomy to QOL score. Statistics were performed using paired, unpaired t tests, and Chi-square. p Values ≤0.05 were considered significant.

Results

35 patients underwent placement of appendicostomy/cecostomy. Fourteen (40 %) patients/families were prospectively contacted (<6, n = 6; >6, n = 8). Stooling scores (15.17 ± 1.35 vs. 22.25 ± 1.70; for <6 vs. >6 years old, p = 0.009) and continence scores (6.33 ± 1.45 vs. 11.13 ± 1.64; p = 0.06), at time of contacting families, were significantly better in those undergoing appendicostomy/cecostomy in the <6 group. Pre-procedure QOL scores for the two groups were similar (p = 0.89). Post-procedure QOL significantly increased to the good subcategory for both age groups; however improvement was significantly better in the <6 age group vs. ≥6 group: 6.33 ± 0.92 vs. 3.13 ± 0.91 points (p = 0.03). A secondary parent survey showed significantly more families wished an appendicostomy/cecostomy were done earlier in the >6 vs. <6 group (87.5 vs. 33 %; p = 0.04).

Conclusion

Early placement of cecostomy or appendicostomy as part of a bowel management program may contribute to improved QOL and functional stooling.

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Authors and Affiliations

  1. Section of Pediatric Surgery, Department of Surgery, University of Michigan Health System, Mott Children’s Hospital, 1540 E. Hospital Dr., SPC 4211, Ann Arbor, MI, 48109-4211, USA

    Jennifer J. Freeman, Siddartha Simha, Marcus D. Jarboe, Peter F. Ehrlich & Daniel H. Teitelbaum

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  1. Jennifer J. Freeman
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  2. Siddartha Simha
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  3. Marcus D. Jarboe
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  4. Peter F. Ehrlich
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  5. Daniel H. Teitelbaum
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Correspondence to Daniel H. Teitelbaum.

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Freeman, J.J., Simha, S., Jarboe, M.D. et al. Antegrade continent enema procedures performed prior to starting school may improve functional stooling and quality of life. Pediatr Surg Int 30, 715–722 (2014). https://doi.org/10.1007/s00383-014-3520-z

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  • DOI: https://doi.org/10.1007/s00383-014-3520-z

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