Miniature Access Chait Cecostomy: A New Approach to the Management of Fecal Incontinence

The antegrade continence enema is a well-established procedure in the management of children with fecal incontinence. Chait and Shandling described the percutaneous approach for the management of these children. This procedure eliminates the need for an operation, can be performed under sedation and local anesthesia, and is clinically effective with minimal morbidity. However, it entails several important disadvantages. First, it is a blind procedure. Second, the cecum is not secured to the abdominal wall. Third, the procedure requires a skilled interventional radiologist. And fourth, it must be performed in two stages.

We chose to alter the procedure by using a miniature access surgical approach. Miniature access Chait cecostomy was performed in four children with fecal incontinence. Under laparoscopic visualization, the cecum was identified, mobilized, and sutured to the anterior abdominal wall; the Chait device was then inserted. The procedure permitted excellent cecal visualization and mobilization. Precise positioning of the device in the cecum was achieved, and the procedure was clinically effective with no postoperative complications.

Miniature access Chait cecostomy for children with fecal incontinence is a safe option. It is a single-stage procedure performed by the surgeon, the same person responsible for the management of potential insertion-related complications and the long-term management of the bowel.