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Laparoscopic-Assisted Percutaneous Endoscopic Cecostomy (LAPEC) in Children and Young Adults

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Objective

We evaluated the safety and efficacy of the laparoscopic-assisted percutaneous endoscopic cecostomy (LAPEC) procedure both in children and young adults, along with review of their pre-operative motility profiles, antegrade continence enema (ACE) regimen, and postoperative complications.

Methods

This retrospective review investigated 38 patients (32 children and 6 young adults) that underwent the LAPEC procedure. Primary outcomes evaluated were success versus failure of the procedure and post-operative complications. Success was defined as daily stool evacuation with minimal to no fecal incontinence per week.

Results

Mean follow up time was 25.8 ± 22.4 months. Indications for LAPEC included slow transit constipation or colonic neuropathy (n = 22), other types of constipation (n = 5), and a variety of congenital disorders (n = 11). The overall success rate was 95% (36/38 patients) with the two failures in children, both attributed to inability to use the tube due to underlying behavioral disorders or severe anxiety. Five patients above age 18 had leakage compared to 6 in the under age 18 group (83% vs. 19, P = 0.003). There were no other significant complications.

Conclusion

LAPEC is a safe and effective means of addressing refractory constipation and fecal incontinence in children and young adults who have failed medical management with minimal post-operative complications.

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Author’s Contribution

Shifra A Koyfman, MD—first author; involved in the acquisition, analysis, and interpretation of data for the work as well as crafting of the manuscript and final approval of the version to be published

Kristen Swartz, RN, NP—involved in the interpretation of the data for the work as well as crafting the manuscript and final approval of the version to be published

Allan M Goldstein, MD—involved in creation of the database, the analysis, and interpretation of data for the work, as well as crafting the manuscript and final approval of the version to be published

Kyle Staller, MD, MPH—last author; supervision of the project, involved in creation of the database for information, the analysis and interpretation of data for the work, as well as crafting the manuscript and final approval of the version to be published

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Authors and Affiliations

  1. Division of Pediatric Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Shifra Koyfman

  2. Department of Pediatric Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Shifra Koyfman, Kristen Swartz & Allan M. Goldstein

  3. Center for Neurointestinal Health, Massachusetts General Hospital, Boston, MA, USA

    Allan M. Goldstein & Kyle Staller

  4. Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Kyle Staller

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  1. Shifra Koyfman
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  2. Kristen Swartz
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  4. Kyle Staller
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Correspondence to Kyle Staller.

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Koyfman, S., Swartz, K., Goldstein, A.M. et al. Laparoscopic-Assisted Percutaneous Endoscopic Cecostomy (LAPEC) in Children and Young Adults. J Gastrointest Surg 21, 676–683 (2017). https://doi.org/10.1007/s11605-016-3353-2

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  • DOI: https://doi.org/10.1007/s11605-016-3353-2

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