Cecostomy Procedures

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Normal Appendix (Left)
Appendix to belly button (Middle)
Appendix to Skin of Right Lower Abdomen (Right)

Percutaneous Cecostomy
A cecostomy tube may be placed in the radiology department by specially trained radiologists, or in the operating room by gastroenterologists. Your child may be given medicine to help him or her sleep through the procedure. A tube that looks like a catheter will be placed in the cecum. After several weeks a smaller device that lays closer to the skin will replace this tube. This results in a plastic tube which can cause skin irritation, and will need to be changed every 2 months or so.

ACE Procedure
An operation to bring the tip of the appendix to the skin. This is done with all natural tissue that is the patient's own, and therefore grows with the patient. This operation involves either an incision or use of the laparoscope (three to five 1/2 inch incisions). The open operation involves a three-day or so stay in the hospital, while the laparoscopic approach usually involves one to two days in hospital.

The appendix can be placed into the belly button where it is hidden. Some people find that they need to wear a gauze pad over the belly button because of mucus staining. The appendix can also be placed in an area where the underwear will be, for concealment. This way, a small piece of gauze can be held in the underwear. If the appendix is not usable, a piece of the intestine is used to construct a catheterizable port.

Usually, the appendix will have a catheter stitched in place for a few weeks postoperatively to help things heal, so plan to go home with this tube. The tube can be used for the antegrade enema procedure typically within a few days of its construction surgically.

Who is this procedure ideal for?
This procedure is ideally done on younger children, that is, the three to six years of age time frame. This is because better outcomes occur in this age group. Waiting until the child is 15 years of age is more frustrating because the colon tends to be chronically over distended and weakened. Therefore, the administration of an antegrade enema is frequently unrewarding, and it is much more difficult to get on a predictable regimen of antegrade enemas.

This procedure can be combined with other procedure(s) in the urinary tract such as augmentation cystoplasty or bladder neck plasty procedures.