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Laparoscopic staplled cecal tube for ACE in a child after Ladd's procedure and appendectomy for malrotation

Paul Philippe, Cindy Gomes, Jerry Kieffer, Monika Glass

Clinique Pédiatrique, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg

 

Abstract 

We present the case of a ten year old boy with operated high anorectal malformation in need for antegrade continence enemas. After years of using a percutaneous Chait button cecostomy, he requested conversion to a tubeless access. He had also underwent a Ladd’s procedure with appendectomy for malrotation associated mid-gut volvulus at 8 month of age. After several years using a Chait’s button, he requested a continent stoma. A conduit was fashionned laparoscopically, using a 14Fr peel-away vascular introducer placed in the umbilicus to calibrate a tubularized caecal flap made with one application of a 45mm endostapler. A 12 Fr Foley catheter was then inserted through the sheat and left in place for 2 weeks. A «fundoplication» of the ceacum was added as an anti-reflux measure. The child was discharged the next day, and enemas restarted at 48 hours. Despite the need for a stoma revision (stenosis) and a rare minor leak, the child and his family are very satisfied.