Laparoscopic Appendicostomy

Abstract

Background and Purpose

: Chronic constipation and encoporesis present many psychosocial problems for patients and their families. Therapy with the antegrade continence enema was initially described by Malone in 1990. We present a series of patients in which a Malone antegrade continence enema was created laparoscopically.

Patients and methods

: Eight patients between 2 and 15 years of age presented for a laparoscopic appendicostomy for the use of antegrade continence enemas. Using an open Hasson technique, a 5-mm laparoscope was placed at the umbilicus. A second port was placed in the right lower quadrant for exteriorization of the appendix. The appendix was matured as originally described by Malone.

Results

: Six of eight patients are continent postoperatively. Seven of eight patients' families were either extremely satisfied or satisfied with the results of the procedure.

Conclusions

: The primary indication for the Malone antegrade continence enema is neurogenic overflow fecal incontinence. It has also been used for patients with anorectal malformations and idiopathic constipation. Patient selection is critical, especially in candidates less than 5 years of age. Laparoscopy offers patients a means to create an appendicostomy without a laparotomy.