wetenschapsdag 2023 | 43 Sessie 1c: We Zullen Doorgaan x4 Auteurs C.A.L. Jonker, M.A. Benninga, I.J.N. Koppen, R.R. Gorter, J.R. de Jong Abstract titel Complications of Chait Cecostomies for Antegrade Continence Enemas (ACE) in Children with Intractable Constipation and/or fecal incontinence; The Amsterdam Experience. Background In pediatric patients with intractable constipation and/or fecal incontinence, antegrade continence enemas (ACE) are considered if conventional management has failed. To enable ACE, several procedures have been described, such as the Malone appendicostomy and the Chait trapdoor cecostomy (CTC). Still, limited data are available regarding the outcomes of CTC, especially complications. We aim to evaluate CTC related complications in children with intractable constipation and/or fecal incontinence. Methods We performed a single-center retrospective study including all children (< 18 years) with intractable constipation and/or fecal incontinence who underwent a CTC procedure between 2009 and 2023 in our tertiary referral center. Medical records were evaluated for postoperative complications. The primary outcome was defined as CTC related complications classified according to the Clavien Dindo classification. Results Sixty-nine patients were included. The median age at surgery was 12.0 years (IQR 8.0, 15.0; range 1-18 years) and 31 patients (44.9%) were male. Most common underlying diagnoses were: chronic functional constipation (65.2%), spina bifida (17.3%) and anorectal malformation (7.2%). In total, 56 patients (81.2%) experienced 98 CTC related complications. Most commonly reported complications were granulation tissue (n=32, 57.1%), pain at the tube site (n=13, 23.2%) and wound infection at the tube site (n= 13, 23.2%). These were all minor complications (Clavien Dindo I-II). Twenty-nine (29.6%) major complications (Clavien Dindo III-IV) were reported by 25 (36.2%) patients, requiring reoperation for surgical repair of the CTC. These most commonly included tube dislodgement (n=10, 17.9%) and a mechanical failure of the CTC (n=4, 7.1%). Conclusion More than 80% of patients who underwent CTC experienced a CTC related complication. The majority were minor complications, although 30% of the reported complications were a major complication, requiring re-operation. This information can be used to adequately inform patients eligible for CTC. Furthermore, this information can be integrated in the ongoing debate regarding the optimal surgical procedure for ACE.
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