Comparison of results of laparoscopic and open antegrade continence enema procedures

Several modifications of the Malone antegrade continence enema (ACE) proced ure have now been reported. In this study we have compared the results of o ur experience with the laparoscopic appendicostomy (LACE procedure) with th e published results of previously described open ACE procedures. Children w ho had the LACE procedure at our institutions were reviewed. Intra- and pos toperative problems were identified by review of hospital case notes and fr om a questionnaire completed by the children's caregivers. These results we re compared with the reported results of the original Malone procedure, the Pena modification, and the open appendicostomy as described by Wilcox. Sin ce 1994, 30 children have had LACE procedures performed at our institutions . Two have required conversion to an open procedure because of difficulty l ocating the appendix. The stoma is being used for regular antegrade colonic washouts in 29 of the 30, compared with 19 of 31 in Malone's series and 16 of 20 in Pena's. Improvement in soiling has been achieved in 27 (90%) of o ur patients, 15 of whom are completely clean, a rate similar to that of the other types of procedure (61%-78%). Stenosis of the stoma has occurred in 8 children (27%), compared with rates of 10%-33% in other series. Stomal le akage has been troublesome for 2 (6.7%), compared with leak rates between 5 .6% and 15% in other series. The LACE procedure is technically the simplest . The laparoscopic approach to the ACE procedure appears to be a simpler an d safe alternative to previously described methods. It causes minimal morbi dity, has a high long-term viability rate, and resulted in improved control of soiling in 90% of the children with faecal incontinence in whom it has been employed.