Antegrade Colonic Enema Channels in Pediatric Patients Using Appendix or Cecal Flap: A Comparative Robotic <i>vs</i> Open Series

Abstract

Introduction: We present perioperative outcomes of a single-center experience with robot-assisted antegrade colonic enema (ACE) channel creation for the treatment of chronic constipation refractory to medical therapy and compare it to the traditional open surgical approach. We also demonstrate a step-by-step video presentation of the robotic approach for cecal flap ACE performed as part of a dual continence procedure in patients with short length of appendix. Methods: A retrospective chart review of pediatric patients who underwent ACE channel creation between 2008 and 2020 was performed. We compared demographics and intraoperative and postoperative variables of the open vs robotic approach. Results: Among 28 patients, 15 were open and 13 robotic. To construct the ACE channel, a cecal flap was utilized in 36%, split appendix in 50%, full-length appendix in 11%, and sigmoid colon in 3% of patients. Both approaches showed equivalent estimated blood loss (50 mL [interquartile range; IQR = 20–100]), median length of hospital stay (7 days vs 8 days, p = 0.7), and median time to return to regular diet (4 days vs 5 days, p = 0.5) ( Table 1 ). Patients in the open group were more likely to have a history of prior abdominal surgeries than those in the robotic group (80% vs 38.5%, p = 0.02). The risk of Clavien-Dindo grade 3 or more complications (40% vs 23.1%, p = 0.04) and the rate of ACE channel stenosis (46.7% vs 7.7%, p = 0.02) were significantly higher in the open approach. Channel stenosis was significantly higher in patients with an appendix ACE channel (87.5% vs 12.5%, p &lt; 0.05) compared to those with cecal flap ACE. Table 1. Demographic, Operative Characteristics, and Complications Among Patients Undergoing Antegrade Colonic Enema and Comparison Between Open Approach and Robotic Approach Total Open Robotic p Patients 28 15 53.60% 13 46.40% 0.027 Age, median (IQR) 9 (6–14) 6 (5–11.5) 12 (9–14) Preoperative diagnosis Spinal dysraphism 26 14 93.30% 12 92.30% 0.92 Cerebral palsy 2 1 6.70% 1 7.70% Prior abdominal procedure 17 12 80.00% 5 38.50% 0.025 Procedures ACE<