<b>Surgical treatment of fecal incontinence</b>Abstracts
<b>Background: </b>Patients with fecal incontinence suffer from serious social and psychological problems. Therefore, the objective was to analyze the evolution of 27 patients who underwent surgery using the Malone, Neo-Malone or Chait’s Button procedures in order to administer an antegrade enema. Also, the study aimed at assessing the effect of performing the procedure on their quality of life. <b>Methods: </b>Research is descriptive and retrospective. Data was obtained from medical records from the period 2000-2010. In order to define a case, patients must have suffered from fecal incontinence and under gone surgery using the Malone, Neo-Malone (flap from de colon) and Chait’s button procedures during such period. <b>Results: </b>Out of the 27 patients analysed, an anorectal deformity was the cause of incontinence in 21, mielomeningocelein 3, Hirschsprung disease in 1, rabdomiosarcoma in 1 and constipation in 1. The Malone procedure was used in 17 of these patients, the Neo-Malone in 6 and the Chait’s Button in 4. The complications observed were: leakage from the neo-appendix with peritonitis and reoperation in 1 case, stenosis of the stoma in 9 cases, granulomas in 4 cases and prolapse in 1 case. In 24 cases, patients keep clean from feces and both, patients and parents are satisfied. In 10 cases, patients are independent and administer their own enemas. <b>Conclusions: </b>The results allow us to consider that surgery to administer an antegrade enema is a good alternative to improve the patient´s quality of life.
Malone; Neo-malone; Chait’s Button; fecal incontinence
<span name="style_bold">Antecedentes: </span>los pacientes con incontinencia fecal enfrentan graves problemas sociales y psicológicos, por lo que el propósito fue analizar la evolución de 27 pacientes operados con la técnica de Malone, de Neo-apéndice y botón de Chait, para hacerles enemas anterógrados, así como evaluar la repercusión en su calidad de vida. <span name="style_bold">Metodología</span>: la investigación es descriptiva-retrospectiva. Los datos se obtuvieron de los expedientes clínicos del periodo 2000-2010. Para la definición de caso fue necesario que tuvieran incontinencia fecal y que se les hubiera hecho una operación de Malone, Neo-apéndice y colocación de botón de Chait durante ese periodo. <span name="style_bold">Resultados: </span>de los 27 pacientes analizados, 21 tenían como causa de la incontinencia una malformación anorrectal, 3 mielomeningocele, 1 enfermedad de Hirschsprung, 1 rabdomiosarcoma y 1 constipación. En 17 se realizó la técnica de Malone, en 6 un Neo-apéndice, y en 4 se colocó un botón de Chait. Las complicaciones observadas fueron: fuga del neo-apéndice con peritonitis y reintervención en 1 caso, estenosis de la boca en 9 casos, granulomas en 4 casos y prolapso en 1. En 24 casos los pacientes se mantienen limpios de heces y tanto ellos como sus familiares están satisfechos. En 10 casos ellos son independientes y se realizan sus propios enemas. <span name="style_bold">Conclusiones: </span>los resultados obtenidos permiten considerar que las intervenciones quirúrgicas efectuadas para hacer los enemas anterógrados, son una buena opción para mejorar la calidad de su vida.los resultados obtenidos permiten considerar que las intervenciones quirúrgicas efectuadas para hacer los enemas anterógrados, son una buena opción para mejorar la calidad de su vida.
Malone; Neo-malone; botón de Chait; incontinencia fecal
<span name="style_bold">Background: </span>Patients with fecal incontinence suffer from serious social and psychological problems. Therefore, the objective was to analyze the evolution of 27 patients who underwent surgery using the Malone, Neo-Malone or Chait’s Button procedures in order to administer an antegrade enema. Also, the study aimed at assessing the effect of performing the procedure on their quality of life. <span name="style_bold">Methods: </span>Research is descriptive and retrospective. Data was obtained from medical records from the period 2000-2010. In order to define a case, patients must have suffered from fecal incontinence and under gone surgery using the Malone, Neo-Malone (flap from de colon) and Chait’s button procedures during such period. <span name="style_bold">Results: </span>Out of the 27 patients analysed, an anorectal deformity was the cause of incontinence in 21, mielomeningocelein 3, Hirschsprung disease in 1, rabdomiosarcoma in 1 and constipation in 1. The Malone procedure was used in 17 of these patients, the Neo-Malone in 6 and the Chait’s Button in 4. The complications observed were: leakage from the neo-appendix with peritonitis and reoperation in 1 case, stenosis of the stoma in 9 cases, granulomas in 4 cases and prolapse in 1 case. In 24 cases, patients keep clean from feces and both, patients and parents are satisfied. In 10 cases, patients are independent and administer their own enemas. <span name="style_bold">Conclusions: </span>The results allow us to consider that surgery to administer an antegrade enema is a good alternative to improve the patient´s quality of life.The results allow us to consider that surgery to administer an antegrade enema is a good alternative to improve the patient´s quality of life.
Malone; Neo-malone; Chait’s Button; fecal incontinence
Norma Ceciliano-Romero y
Silvia Cordero-Castro
Work performed at the Department of General Surgery, National Children’s Hospital “Dr. Carlos Sáenz Herrera”. * nocerodd@hotmail.com Support sources: no financial aid was available.
Resumen
2010. In order to define a case, patients must have suffered from fecal incontinence and under gone surgery using the Malone, Neo-Malone (flap from de colon) and Chait’s button procedures during such period.
1 There are also other conditions such as myelomeningocele, which also leave patients incontinent. Sequels that this problem presents are important psychological disorders, school dropouts, family dysfunction and social disapproval. To try and correct these problems the colorectal disorders Clinic was created, where 27 patients has been controlled undergoing the following procedures: Malone and neo-appendix, which are two different techniques to treat the problem in the first one, using the cecal appendix, and the second one, with a duct of the colon wall. (Figure 1), which have a particular relationship to the skin, which allows to perform cleansing enemas inversely to the traditional or in the same direction of the bowel movements. This is what has been called antegrade enemas. In some patients the Chait’s button was inserted, a plastic device used to communicate the large intestine in its antimesenteric border with the skin at the front of the abdomen, usually placed on the right side. (Figure 2)
2 and if it was performed with open or laparoscopic surgery. Complications that were presented in each of the procedures are also analyzed. Finally, the results were analyzed, assessing if the patient was kept clean, if they were able to perform the enemas on their own, and what their and their family’s level of satisfaction was.
The pathology that led to incontinence is shown in (Table 1). The surgery performed consisted of 18 procedures performed with open surgery, where a laparotomy was performed and 9 underwent the laparoscopic technique. The Malone technique was performed on 17, the neo-appendix on 6 and the placement of a Chait’s button on 4.
Table 2. The only complication of peritonitis was in one case of neoappendix, and granuloma was more common when the Chait’s button was used.
1,3
4,5 the outlet of the duct was attempted to be placed in the umbilical scar for aesthetic reasons and to not interfere with concomitant urologic procedures, since some of these patients also deserve urinary system surgery.6,7 When Chait’s button was inserted,8 the cecum was used and this was located on the right side of the abdomen.
9 Granulomas were treated with applications of sodium chloride or mercurochrome. Mucosa prolapse required a reoperation for correction. In order to prevent leakage of intestinal contents into the cavity and subsequent peritonitis, the cecum is attached to the abdominal wall.
References
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1. Peña A, Hong A. Advances in the Management of Anorectal Malformations. Am J Surg2000; 180:370-376.
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2. Peña M, Parés D, Pascual M, Pérez M, Cañete N, Sánchez M, Andréub M, Grande L. Tratamiento del estreñimiento crónico grave mediante la técnica del enema anterógrado continenete. Cir Esp2008; 80: 403-405.
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3. Peña A, Guardino K, Tovilla J, Levitt M, Rodríguez G, Torres R. Bowel Management for Fecal Incontinence in Patients with Anorectal Malformations. J Pediatr Surg1998; 33:133-137.
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4. Levitt A, Soffer S, Peña A. Continent appendicostomy in the bowel management of fecally incontinent children. J Pediatr Surg1997; 32:1630-1633.
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5. Weiser A, Stock J, Hanna M. Modified cecal flap noeappendix for Malone antegrade continence enema procedure: a novel technique. J Pediatr Urol2003; 169: 2321-2324.
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6. Meurette G, Lehur P, Coron E, Regenet N. Long-term results of malone´s procedure with antegrade irrigaton for severe choronic constipation. Gastroenterol Clin Biol2010; 34:209-212.
-
7. Bau MO, Younes S, Aupy A, Bernuy M, Rouffet MJ, Yepremian D, Lottman HB. The Malone antegrade colonic enema isolated or associated with urological inconticence procedueres: evaluation from patient point of view. J Pediatr Urol2001; 165: 2399-2403.
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8. Becmeur F, Demarche M, Lacreuse I, Molinaro F, Kauffmann I, Moog R, et al. Cecostomy button for antegrade enemas: survey of 29 patients. J Pediatr Surg2008; 43: 1853-1857.
-
9. Shaul DB, Harrison EA, Muenchow SK Avoidance of leakage and strictures when creatinag an invisible conduit for anterograde colinic enemas. J Pediatr Surg2002; 37: 12, 1768-1771.
References
-
1. Peña A, Hong A. Advances in the Management of Anorectal Malformations. Am J Surg2000; 180:370-376.
-
2. Peña M, Parés D, Pascual M, Pérez M, Cañete N, Sánchez M, Andréub M, Grande L. Tratamiento del estreñimiento crónico grave mediante la técnica del enema anterógrado continenete. Cir Esp2008; 80: 403-405.
-
3. Peña A, Guardino K, Tovilla J, Levitt M, Rodríguez G, Torres R. Bowel Management for Fecal Incontinence in Patients with Anorectal Malformations. J Pediatr Surg1998; 33:133-137.
-
4. Levitt A, Soffer S, Peña A. Continent appendicostomy in the bowel management of fecally incontinent children. J Pediatr Surg1997; 32:1630-1633.
-
5. Weiser A, Stock J, Hanna M. Modified cecal flap noeappendix for Malone antegrade continence enema procedure: a novel technique. J Pediatr Urol2003; 169: 2321-2324.
-
6. Meurette G, Lehur P, Coron E, Regenet N. Long-term results of malone´s procedure with antegrade irrigaton for severe choronic constipation. Gastroenterol Clin Biol2010; 34:209-212.
-
7. Bau MO, Younes S, Aupy A, Bernuy M, Rouffet MJ, Yepremian D, Lottman HB. The Malone antegrade colonic enema isolated or associated with urological inconticence procedueres: evaluation from patient point of view. J Pediatr Urol2001; 165: 2399-2403.
-
8. Becmeur F, Demarche M, Lacreuse I, Molinaro F, Kauffmann I, Moog R, et al. Cecostomy button for antegrade enemas: survey of 29 patients. J Pediatr Surg2008; 43: 1853-1857.
-
9. Shaul DB, Harrison EA, Muenchow SK Avoidance of leakage and strictures when creatinag an invisible conduit for anterograde colinic enemas. J Pediatr Surg2002; 37: 12, 1768-1771.
Publication Dates
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Publication in this collection
11 Sept 2014 -
Date of issue
Sept 2013
History
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Received
25 Sept 2012 -
Accepted
25 Apr 2013
