PDF icon Download PDF
Eur J Pediatr Surg 2025; 35(04): 286-294
DOI: 10.1055/a-2511-9184
Original Article

Outcomes and Complications of Chait Trapdoor Cecostomy in Pediatric Patients with Therapy-Resistant Constipation and Fecal Incontinence: A 14-Year Retrospective Study

Charlotte Anne Louise Jonker
1   Department of Pediatric Surgery, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
2   Department of Pediatric Gastroenterology and Nutrition, Amsterdam UMC Locatie AMC, Amsterdam, Noord-Holland, The Netherlands
3   Amsterdam UMC, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
4   Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
,
Ilan Koppen
2   Department of Pediatric Gastroenterology and Nutrition, Amsterdam UMC Locatie AMC, Amsterdam, Noord-Holland, The Netherlands
3   Amsterdam UMC, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
,
Marc A. Benninga
2   Department of Pediatric Gastroenterology and Nutrition, Amsterdam UMC Locatie AMC, Amsterdam, Noord-Holland, The Netherlands
3   Amsterdam UMC, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
,
Justin R. de Jong
1   Department of Pediatric Surgery, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
,
Ramon Gorter
1   Department of Pediatric Surgery, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
3   Amsterdam UMC, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
4   Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
› Author Affiliations
Funding This research was funded by the Hartwig Foundation.
› Further Information
Also available ateRef
   Permissions and Reprints
Preview

Abstract

Aim of the Study To assess the incidence and types of complications and patient-reported outcomes in pediatric patients with therapy-resistant constipation or fecal incontinence (FI) without constipation who underwent Chait Trapdoor™ cecostomy (CTC). The findings contribute to the discussion on selecting the optimal antegrade continence (ACE) procedure for this population.

Materials and Methods A retrospective review was conducted on all pediatric patients with therapy-resistant constipation or FI without constipation who underwent a CTC procedure at our tertiary referral center between 2009 and 2023. Postoperative complications were classified using the Clavien-Madadi classification. At their most recent follow-up in 2023, patients reported satisfaction with their CTC.

Results The study included 62 children (median age 12 years [IQR 8–14; range 1–17], 42% male), with a median follow-up of 4 years (IQR 2–8, range 0–14). Underlying diagnoses were functional constipation (n = 39, 63%), spina bifida (n = 11, 18%), and anorectal malformations (n = 5, 8%). A total of 49/62 patients (79%) experienced 89 CTC-related complications. Minor complications (Clavien-Madadi I–II) affected 29 patients (47%) and most commonly included granulation. Major complications (Clavien-Madadi III–IV) requiring surgery occurred in 32% of patients. Despite these complications, 40/62 (65%) patients reported satisfaction with their CTC, as determined by partial or complete symptom resolution.

Conclusions Although complications were common, 65% of the patients reported satisfaction with their CTC. These findings emphasize the need for thorough patient selection, informed counseling on potential risks, and individualized management strategies to enhance outcomes.

Keywords

pediatrics - fecal incontinence - constipation - Chait Trapdoor cecostomy - antegrade continence enema


Publication History

Received: 17 July 2024

Accepted: 07 January 2025

Accepted Manuscript online:
09 January 2025

Article published online:
14 February 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

  • References

  • 1 Koppen IJN, Vriesman MH, Saps M. et al. Prevalence of functional defecation disorders in children: a systematic review and meta-analysis. J Pediatr 2018; 198: 121-130.e6
    Search in Google Scholar
  • 2 Tabbers MM, DiLorenzo C, Berger MY. et al; European Society for Pediatric Gastroenterology, Hepatology, and Nutrition, North American Society for Pediatric Gastroenterology. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr 2014; 58 (02) 258-274
    Search in Google Scholar
  • 3 Siminas S, Losty PD. Current surgical management of pediatric idiopathic constipation: a systematic review of published studies. Ann Surg 2015; 262 (06) 925-933
    Search in Google Scholar
  • 4 Malone PS, Ransley PG, Kiely EM. Preliminary report: the antegrade continence enema. Lancet 1990; 336 (8725): 1217-1218
    Search in Google Scholar
  • 5 Shandling B, Chait PG, Richards HF. Percutaneous cecostomy: a new technique in the management of fecal incontinence. J Pediatr Surg 1996; 31 (04) 534-537
    Search in Google Scholar
  • 6 Abildgaard HA, Børgager M, Ellebæk MB, Qvist N. Ileal neoappendicostomy for antegrade colonic enema (ACE) in the treatment of fecal incontinence and chronic constipation: a systematic review. Tech Coloproctol 2021; 25 (08) 915-921
    Search in Google Scholar
  • 7 Ahn SM, Han SW, Choi SH. The results of antegrade continence enema using a retubularized sigmoidostomy. Pediatr Surg Int 2004; 20 (07) 488-491
    Search in Google Scholar
  • 8 Kelly MS. Malone antegrade continence enemas vs. cecostomy vs. transanal irrigation—what is new and how do we counsel our patients?. Curr Urol Rep 2019; 20 (08) 41
    Search in Google Scholar
  • 9 Halleran DR, Vilanova-Sanchez A, Rentea RM. et al. A comparison of Malone appendicostomy and cecostomy for antegrade access as adjuncts to a bowel management program for patients with functional constipation or fecal incontinence. J Pediatr Surg 2019; 54 (01) 123-128
    Search in Google Scholar
  • 10 Marshall J, Hutson JM, Anticich N, Stanton MP. Antegrade continence enemas in the treatment of slow-transit constipation. J Pediatr Surg 2001; 36 (08) 1227-1230
    Search in Google Scholar
  • 11 Hoekstra LT, Kuijper CF, Bakx R, Heij HA, Aronson DC, Benninga MA. The Malone antegrade continence enema procedure: the Amsterdam experience. J Pediatr Surg 2011; 46 (08) 1603-1608
    Search in Google Scholar
  • 12 Vriesman MH, Koppen IJN, Camilleri M, Di Lorenzo C, Benninga MA. Management of functional constipation in children and adults. Nat Rev Gastroenterol Hepatol 2020; 17 (01) 21-39
    Search in Google Scholar
  • 13 Knaus ME, Lu PL, Lu A. et al. Antegrade continence enemas in children with functional constipation and dyssynergic defecation: go or no go?. J Pediatr Surg 2022; 57 (08) 1672-1675
    Search in Google Scholar
  • 14 Christison-Lagay ER, Rodriguez L, Kurtz M, St Pierre K, Doody DP, Goldstein AM. Antegrade colonic enemas and intestinal diversion are highly effective in the management of children with intractable constipation. J Pediatr Surg 2010; 45 (01) 213-219 , discussion 219
    Search in Google Scholar
  • 15 Reppucci ML, Nolan MM, Cooper E. et al. The success rate of antegrade enemas for the management of idiopathic constipation. Pediatr Surg Int 2022; 38 (12) 1729-1736
    Search in Google Scholar
  • 16 Available at: https://data.castoredc.com/studies/YkxpjCV7Kv4kFuw2Aby9ha/participants
  • 17 Madadi-Sanjani O, Kuebler JF, Brendel J. et al. Implementation and validation of a novel instrument for the grading of unexpected events in paediatric surgery: Clavien-Madadi classification. Br J Surg 2023; 110 (05) 576-583
    Search in Google Scholar
  • 18 Madadi-Sanjani O, Kuebler JF, Brendel J. et al. Validation of the Clavien-Madadi classification for unexpected events in pediatric surgery: a collaborative ERNICA project. J Pediatr Surg 2024; 59 (09) 1672-1679
    Search in Google Scholar
  • 19 Mousa HM, van den Berg MM, Caniano DA, Hogan M, Di Lorenzo C, Hayes J. Cecostomy in children with defecation disorders. Dig Dis Sci 2006; 51 (01) 154-160
    Search in Google Scholar
  • 20 Bevill MD, Bonnett K, Arlen A, Cooper C, Baxter C, Storm DW. Outcomes and satisfaction in pediatric patients with Chait cecostomy tubes. J Pediatr Urol 2017; 13 (04) 365-370
    Search in Google Scholar
  • 21 Donkol RH, Al-Nammi A. Percutaneous cecostomy in the management of organic fecal incontinence in children. World J Radiol 2010; 2 (12) 463-467
    Search in Google Scholar
  • 22 Baaleman DF, Vriesman MH, Lu PL. et al. Long-term outcomes of antegrade continence enemas to treat constipation and fecal incontinence in children. J Pediatr Gastroenterol Nutr 2023; 77 (02) 191-197
    Search in Google Scholar
  • 23 Steiner SA, Torres MR, Penna FJ. et al. Chronic functional constipation in children: adherence and factors associated with drug treatment. J Pediatr Gastroenterol Nutr 2014; 58 (05) 598-602
    Search in Google Scholar
  • 24 Basson S, Zani A, McDowell S. et al. Antegrade continence enema (ACE): predictors of outcome in 111 patients. Pediatr Surg Int 2014; 30 (11) 1135-1141
    Search in Google Scholar
  • 25 Mosiello G, Marshall D, Rolle U. et al. Consensus review of best practice of transanal irrigation in children. J Pediatr Gastroenterol Nutr 2017; 64 (03) 343-352
    Search in Google Scholar