Is The Cecal/Colonic Flap Inferior To The Appendix And The Monti Reconfigured Ileum For The Malone...

S86 ESPU Programme 2009

CONCLUSIONS

Transplanting muscle progenitor cellsshowed the potential for recapitulation of

a myogenic program when injected intodeficient anal sphincter. Myoblast-mediatedcellular anal myoplasty warrants additional

investigation as a new method to treatmentof fecal incontinence.

# S14-8 (PP)

Ezekiel LANDAU1, Ofer GOFRIT2, Dov PODE2, Mordechai DUVDEVANI2, Benjamin HARDAK3, Helio CIPELE3 andOfer SHENFELD2

1Hadassah Hebrew University Medical Center, Pediatric Urology, Jerusalem, ISRAEL, 2Hadassah Hebrew University Medical Center,Urology, Jerusalem, ISRAEL, 3Hadassah Hebrew University Medical Center, Pediatric Urology Unit, Jerusalem, ISRAEL

PURPOSE

Cecal/colonic flap (CCF) has been suggestedas an alternative to the appendix or Montireconfigured ileum (MRI) for the Maloneantegrade continence enema (MACE)procedure in children. The literatureregarding its efficiency is scant. We,therefore, analyzed our results of MACE, andcompared these 3 alternative techniques,regarding stomal incontinence, andstenosis/obstruction.

MATERIAL AND METHODS

We conducted a retrospective chart search.All patients who underwent the MACEprocedures at our institute were included inour study.

RESULTS

Seventeen patients with fecal incontinence(11 males, 6 females; mean age 12.8 years)underwent the MACE procedure between1998 and 2008. Diagnoses includedmyelodysplasia (8 patients), anorectalmalformations (6), sacral agenesis (2), andpelvic trauma (1). The MACE conduits wereconstructed using the appendix in 5patients, MRI in 8, and CCF in 4. One patientwith an appendix-MACE underwent dilationof a stenosed stoma. In two of the patientswith MRI revision was necessary forobstruction/stenosis. No appendix or MRIconduits leaked. All 4 patients with CCFconduits became incontinent 6 to 24 monthsfollowing surgery. One of these patients alsorequired dilation for stomal stenosis.

Attempts to cure incontinence bysubmucosal injection of dextronomer/hyaluronic acid at the conduit-colonjunction failed in 2 patients. Two CCFconduits were successfully replaced by MRI,1 was replaced by button cecostomy, and 1 isawaiting reconstruction.

CONCLUSIONS

Our initial results reveal that CCF has failedas a conduit for the MACE procedure becauseof 100% stomal incontinence. We, therefore,abandoned this procedure, andrecommend the appendix or MRI for MACEprocedures.

# S14-9 (PP)

Brendon BOWKETT and Erica WHINEARY-KELLYWellington Childrens Hospital, Paediatric Surgery, Wellington, NEW ZEALAND

PURPOSE

Faecal impaction and incontinence are oftenpart of the symptom complex in manypaediatric urological patients with severeanomalies. Antegrade enemas through anappendicostomy are sometimes required.Should the appendix be absent or utilized foranother purpose then a chait tube orcaecostomy button can provide colonicaccess. However these devices may beassociated with breakages, accidentalremoval and, leakage.Replacement mayrequire a general anaesthetic. Full thicknesscolonic tubes can also be constructed butare associated with leakage of both gas andfaecal material. The construction ofa mucosal colonic tube with antireflux wrapavoids the above problems and isadvantageous in urological patients.

MATERIAL AND METHODS

Six children (4 spinabifida) were selectedTechnique At variable sites in the colona small full thickness rectangular flap isopened and swung laterally. The mucosaalone is sutured to form a tube which isfundoplicated at its base by adjacent colonand brought to the skin to create a fistula.

RESULTS

The effectiveness was evaluated usinga modified quality of life score(QOLI). Thescore assessed soiling, staining, odour, selfesteem and socialization. The ease ofcatheterization and continence of themucosal fistula site was assessed. Follow up :Median 62 months Range (19 e 68) QOLI

scores improved from 4.75 to 18.5 Possiblerange(0 e 21) All fistula sites catheterizeeasily with no stenosis or faecal leakage.Two patients required treatment for minorskin granulations. Despite the small numbersof patients the follow up has been fora considerable period with all stable on theircatheterization with excellent faecalcontinence.

CONCLUSIONS

The mucosal colonic tube is a new techniquethat provides excellent access to the colonfor a group of previously difficult urologicalpatients.