Background: The antegrade continence enema is an effective method of treatment of fecal incontinence. We report our experience of a laparoscopic antegrade continence enema procedure and describe
a simple approach to this procedure using a two-port technique.
Materials and Methods: Over a 3-year period, 12 children with intractable constipation and fecal soiling underwent the antegrade continence enema procedure laparoscopically. All cases had full
bowel preparation the day before surgery. This procedure was done through one 5-mm camera port
and two 5-mm working ports in 8 cases, and using the camera port and only one additional 5-mm
working port in 4 cases. The appendix was used in 5 cases and the cecum in 3 cases with the threeport
technique while the appendix was used in all 4 cases with the two-port technique. The appendix
or cecum was delivered extracorporeally through the 5-mm port site in the right lower quadrant.
The mucocutaneous anastomosis was stented using a gastrostomy button.
Results: Between 2001 and 2004, 12 children (10 male, 2 female) underwent a laparoscopic antegrade continence enema procedure at a median age of 10.5 years (range, 7–14 years). This procedure
was easy to perform and no case required conversion to an open procedure. The wash-outs
via the MIC-KEY gastrostomy button (MIC-KEY, Kimberly-Clark) were commenced at a median
of 3.5 days (range, 1–5 days). Median postoperative hospital stay was 2 days (range, 1–5 days). This
procedure was effective in completely resolving fecal incontinence in 9 cases and partially resolving
it in 3 cases. There were no episodes of stomal stenosis, leakage, or herniation. However, one case
required a revision of antegrade continence enema due to wound breakdown and leakage of irrigation
fluid around the stoma. The median follow-up period was 15.5 months (range, 5–32 months).
Conclusion: The laparoscopic technique is a simple and effective approach in creating an antegrade continence enema. The use of a gastrostomy button can potentially reduce some of the complications
commonly associated with an antegrade continence enema. We describe a procedure that
incorporates the advantages of both laparoscopy and a button device, which is simple and easy to
perform using just two ports.
