David W Chapman Steven Tong Peter Metcalfe Nathan Hoy Darcie Kiddoo Division of Urology Department of Surgery University of Alberta None Disclosures Bowel Dysfunction is a common problem in the Pediatric Urology Patient ID: 908949
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Evaluating Success and Complications of Cecostomy Tube Insertion for Patients with Bowel Dysfunction: A Retrospective Review
David W. Chapman, Steven Tong, Peter Metcalfe, Nathan Hoy, Darcie KiddooDivision of Urology, Department of Surgery, University of Alberta
Slide2NoneDisclosures
Slide3Bowel Dysfunction is a common problem in the Pediatric Urology Patient Standard treatment for refractory constipation and fecal incontinence is an antegrade enemaCecostomy Tubes versus Malone Antegrade Continence Enema Background
Slide4Most commonly inserted in the IR Suite by Radiologist under general anesthesia (administered by anesthesiologist)Requires annual exchangesCan frequently fall out, fracture, and/or leak at site of insertion Cecostomy Tube
Slide5Objectives Evaluate the success and complication rate for insertion of cecostomy tubes Evaluate the frequency of unplanned cecostomy tube exchanges
Slide6MethodsRetrospective Review of 45 charts of patients that underwent cecostomy tube insertion between 2002 and 2018. Primary Outcome: Defined as continence at 1 year follow-upSecondary Outcomes: 30 day complication rate (Clavien Dindo ≥3) Unplanned exchanges (an event that resulted in early exchange) Number of general anesthetics required and age at last GA Length of Hospital Stay (days) Follow Up: Continence at most recent follow upStatistics: Descriptive statistics and linear regression used to evaluate risk factors for success rate and frequency of unplanned exchanges
Slide7Number of Patients 41Patient Age (years) 9.9 (2-37)
Male 25 (60.9%)Female 16 (39.0%)Developmental Delay 8 ( 19.5%)Etiology ---- Spina Bifida20 (48.8%)
Imperforate Anus
13 (31.7%)
Function/Behavioral
4 (9.8%)
Hypotonia/motor dysfunction
3 (7.3%)
Spinal Cord Tumor
1 (2.4%)
Demographics
Slide8Fecal Continence Achieved37 (90.2%)Switched from MACE to cecostomy tube5 (12.2%)
Switched from Cecostomy tube to MACE3 (7.3%)Complications (CD ≥ 3)3 (7.3%) Failed Insertion1 (2.4%) Intra-abdominal Sepsis 2 (4.8%)
Outcomes
Slide9At least one unplanned exchange30 (73.1%)Average Rate of Exchange (per patient/per year)1.3 [0.7-3.2]
Average # of unplanned exchanges 2.0 [0- 10]Total Number of Anesthetics (Average)3.6 [1-15]Average Age at which GA not required 14.9Unplanned Exchanges and Anesthetic Use
Slide10Developmental Delay, age at time of insertion, and gender had no association with the frequency of unplanned exchanges (p>0.05)
Slide11Cecostomy tube use is a safe and effective method for the treatment of refractory constipation and fecal incontinenceUnplanned exchanges due to malfunction, mechanical breakage, or becoming dislodged are frequent. Appropriate Counselling is required about the long-term commitment that may be required for high rate of continenceConclusions