Background: Children with spina bifida, high anorectal anomalies, or neuronal intestinal dysplasia
who are treated with a laparoscopic antegrade continence enema to achieve a socially acceptable
level of fecal continence sometimes have problems with the stoma and its catheterization. The goal
of this study was to determine the nature and incidence of these problems, and their relationship to
the underlying condition.
Materials and Methods: A retrospective review of the hospital case notes of 74 consecutive patients
who had a laparoscopic antegrade continence enema was undertaken.
Results: The laparoscopic antegrade continence enema procedure is well tolerated but is associated
with a variety of usually minor complications including stomal stenosis, leakage, peristomal infection,
granulation tissue overgrowth, mucosal prolapse, abdominal discomfort during irrigation,
appendiceal false passage, and ineffective irrigation. Surgical revision of the stoma was required in
19% of the cases in this study, usually because of stenosis and skin overgrowth. Ongoing problems
achieving colonic emptying were most likely to occur in patients with an anorectal malformation.
Conclusion: Overall, the laparoscopic antegrade continence enema provides an effective method
of facilitating emptying of the bowel. However, it has a high incidence of minor troublesome problems,
with stenosis and skin overgrowth of the stoma being the most common. Younger children
tend to have more complications and difficulty performing effective irrigation. Children with anorectal
malformations were more likely to require surgical revision of the stoma, and often needed ongoing
manual evacuation and bowel washouts despite the laparoscopic antegrade continence enema.
