Y-appendicoplasty: a technique to minimize stomal complications in antegrade continence enema

Abstract

Purpose: The Antegrade Continence Enema (Ace) Is An Effective Method Of Treatment Of Fecal Incontinence And Constipation. However, The Original Procedure Described Is Not Easy To Perform And Is Associated With A High Complication Rate, Especially Stomal Stenosis-Necrosis (55%). Even With Introduction Of Orthotopic Appendicostomy, Composite Series Still Report An Incidence Of 30% With Stomal Problems. The Authors Report A Virtually Complication-Free Simple Modification, The Y-Appendicoplasty. Methods: The Base Of The Appendix Is Imbricated Into Cecum By 2 Successive Rows Of Interrupted Seromuscular Stitches. A Small Y-Shaped Incision Is Made On The Abdominal Wall At Mcburney's Point, And 3 Triangular Skin Flaps Are Raised. The Appendix Is Brought Out Of The Skin Incision. The Tip Is Excised, And 3 Vertical Cuts Are Made 120°Apart. The 3 Appendiceal Flaps Thus Created Are Interdigitated With The Skin Flaps Using Interrupted Sutures. Results: Twelve Children Underwent Y-Appendicoplasty And Orthotopic Appendicostomy. Mean Operating Time Was 1 Hour. None Experienced Stomal Complications That Required Intervention. Control Of Fecal Continence With Ace Ranged From Excellent To Good. Conclusion: Y-Appendicoplasty And Orthotopic Appendicostomy Minimizes Complications For Ace And Is Easy To Perform.