Antegrade continent enema procedures performed prior to starting school may improve functional stooling and quality of life

A major research gap is determining the best age to perform an appendicostomy or cecostomy. This study hypothesizes that performance of appendicostomy/cecostomy prior to starting school (< 6 years) would improve functional stooling and quality of life (QOL). Patients who underwent appendicostomy/cecostomy for bowel management between 2003 and 2013 were retrospectively identified. Families were prospectively surveyed regarding current stooling habits (17 items) and a (7 item) pediatric QOL survey. Lower stooling survey scores represent better bowel control. Higher QOL scores indicated better quality. The primary outcome was to correlate age of appendicostomy/cecostomy to QOL score. Statistics were performed using paired, unpaired t tests, and Chi-square. p Values a parts per thousand currency sign0.05 were considered significant. 35 patients underwent placement of appendicostomy/cecostomy. Fourteen (40 %) patients/families were prospectively contacted (< 6, n = 6; > 6, n = 8). Stooling scores (15.17 +/- A 1.35 vs. 22.25 +/- A 1.70; for < 6 vs. > 6 years old, p = 0.009) and continence scores (6.33 +/- A 1.45 vs. 11.13 +/- A 1.64; p = 0.06), at time of contacting families, were significantly better in those undergoing appendicostomy/cecostomy in the < 6 group. Pre-procedure QOL scores for the two groups were similar (p = 0.89). Post-procedure QOL significantly increased to the good subcategory for both age groups; however improvement was significantly better in the < 6 age group vs. a parts per thousand yen6 group: 6.33 +/- A 0.92 vs. 3.13 +/- A 0.91 points (p = 0.03). A secondary parent survey showed significantly more families wished an appendicostomy/cecostomy were done earlier in the > 6 vs. < 6 group (87.5 vs. 33 %; p = 0.04). Early placement of cecostomy or appendicostomy as part of a bowel management program may contribute to improved QOL and functional stooling.