Percutaneous cecostomy: updates in technique and patient care

PURPOSE: To evaluate the authors' 7-year experience with the percutaneous cecostomy procedure and the long-term outcome of the procedure. MATERIALS AND METHODS: Since 1994, 163 tube cecostomies for fecal incontinence were performed in patients aged 2-23 years and who weighed 8-72 kg (mean, 32.2 kg). Underlying conditions included spina bifida (n = 106), imperforate anus (n = 53), Klippel-Feil deformity (n = 1), cerebral palsy (n = 1), Hirschsprung disease (n = 1), and paraplegia (n = 1). Ventriculoperitoneal shunts were present in 85 (52%) of the 163 patients. The authors have followed up 124 (76%) of the 163 cecostomy patients. Information regarding enema technique, satisfaction with the procedure, postprocedure problems, and long-term outcome of the procedure was obtained by interviewing either the patients or the parents. RESULTS: Tube placement was successful in all patients. One hundred ten (89%) of the 124 patients experienced a substantial decrease in the frequency of soiling accidents. The vast majority of patients expressed satisfaction with the procedure; 117 (94%) of the 124 patients rated the cecostomy procedure as better than the bowel control procedure used before. Late complications of the procedure included granulation tissue and accidentally dislodged tubes. Four patients elected to have their tubes removed for aesthetic and tube management reasons. There was no mortality related to the procedure, although one patient died of pneumonia 5 years later. CONCLUSION: The percutaneous cecostomy procedure is a safe and effective method for treating fecal incontinence.