Abstract
Introduction:
We present perioperative outcomes of a single-center experience with robot-assisted antegrade colonic enema (ACE) channel creation for the treatment of chronic constipation refractory to medical therapy and compare it to the traditional open surgical approach. We also demonstrate a step-by-step video presentation of the robotic approach for cecal flap ACE performed as part of a dual continence procedure in patients with short length of appendix.
Methods:
A retrospective chart review of pediatric patients who underwent ACE channel creation between 2008 and 2020 was performed. We compared demographics and intraoperative and postoperative variables of the open vs robotic approach.
Results:
Among 28 patients, 15 were open and 13 robotic. To construct the ACE channel, a cecal flap was utilized in 36%, split appendix in 50%, full-length appendix in 11%, and sigmoid colon in 3% of patients. Both approaches showed equivalent estimated blood loss (50 mL [interquartile range; IQR = 20–100]), median length of hospital stay (7 days vs 8 days, p = 0.7), and median time to return to regular diet (4 days vs 5 days, p = 0.5) (Table 1). Patients in the open group were more likely to have a history of prior abdominal surgeries than those in the robotic group (80% vs 38.5%, p = 0.02). The risk of Clavien-Dindo grade 3 or more complications (40% vs 23.1%, p = 0.04) and the rate of ACE channel stenosis (46.7% vs 7.7%, p = 0.02) were significantly higher in the open approach. Channel stenosis was significantly higher in patients with an appendix ACE channel (87.5% vs 12.5%, p < 0.05) compared to those with cecal flap ACE.
Demographic, Operative Characteristics, and Complications Among Patients Undergoing Antegrade Colonic Enema and Comparison Between Open Approach and Robotic Approach
Total
Open
Robotic
p
Patients
28
15
53.60%
13
46.40%
0.027
Age, median (IQR)
9 (6–14)
6
(5–11.5)
12
(9–14)
Preoperative diagnosis
Spinal dysraphism
26
14
93.30%
12
92.30%
0.92
Cerebral palsy
2
1
6.70%
1
7.70%
Prior abdominal procedure
17
12
80.00%
5
38.50%
0.025
Procedures
ACE
28
15
100.00%
13
100.00%
APV
19
8
53.30%
11
84.60%
0.077
Monti
5
5
33.30%
0
0.00%
0.044
BA
16
7
46.70%
9
69.20%
0.25
Bladder neck reconstruction
8
6
40.00%
2
15.40%
0.15
Bladder neck closure
2
0
0.00%
2
15.40%
0.22
ACE channel technique
Appendix
3
1
6.70%
2
15.40%
0.53
Split appendix
14
7
46.70%
7
53.80%
0.71
Cecal flap
10
6
40.00%
4
30.80%
0.62
Sigmoid colon
1
1
6.70%
0
0.00%
0.96
Estimated blood loss (mL), median (IQR)
50 (20–100)
50
(35–75)
50
(20–100)
0.93
Return to diet, median (IQR)
4 (3–7)
5
(3–7)
4
(3–4)
0.5
Length of hospital stay, median (IQR)
7 (6–10)
8
(7–11)
7
(6–10)
0.74
Complications
ACE suprafascial stomal stenosis
4
4
26.70%
0
0.00%
0.11
ACE subfascial stomal stenosis
4
3
20.00%
1
7.70%
0.45
Total ACE channel stenosis
8
7
46.70%
1
7.70%
0.023
ACE channel-related Clavien grade 3 or more complication (0: No, 1: Yes)
9
6
40.00%
3
23.10%
0.037
Conclusion:
Robot-assisted ACE channel creation is a safe and acceptable alternative with a significantly lower rate of channel stenosis and other clavien dindo grade 3 complications compared to the traditional open approach. Cecal flaps are also at a lower risk of stomal stenosis than appendix.
Get full access to this article
View all access options for this article.
References
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
