Appendicostomy refers to a novel surgical procedure utilized as an antegrade continent enema for the management of fecal incontinence, soiling, colonic dysmotility and intractable slow transit constipation in children and adults. The appendix is brought to the skin, usually through the navel, as a small stomal conduit, to be catheterized on a daily basis or regularly and used for antegrade colonic irrigation washouts achieving socially acceptable fecal continence and cleansing. The appendicostomy procedure can be done open or laparoscopically. The laparoscopy approach has less operative trauma, less pain, better cosmetic results and can be performed as an outpatient procedure. During the procedure a silastic catheter or a Chait button is inserted. Cecal wrap and fixation as antireflux measures have been recommended but they have not eliminated fecal leak or reflux and increase operative time. The most important variables that predict outcome are patient compliance, regular use of the irrigations and patient age. Complications of using the appendix as conduit include painful catheter insertion related to stomal stenosis since many children avoid regular prophylactic catheter insertion. This problem can also be overcome using constantly an indwelling tube or the Chait button. Mucus leak is common during the first 6-8 weeks. The washout regime can cause significant pain due to volume or content (senna). Other less common complications of the appendicostomy include bleeding, granulation tissue, perforation, infection, embarrassment about the catheter and fecal leak. The appendicostomy procedure effectively reduces soiling in more than 80% of children with idiopathic constipation so long as the parents are motivated to perform the antegrade enemas on a daily basis. Abdominal pain common in chronic constipation is significantly reduced in severity and frequency in these patients. In the preschool child the benefits are earlier cleanness before starting school with less incidence of stenosis and leakage.
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