Transumbilical laparoscopy-assisted Malone procedure in children

Abstract

The aim is to evaluate the outcome of transumbilical laparoscopy-assisted Malone procedure in children. The patients underwent transumbilical laparoscopy-assisted Malone procedure between July 2013 and December 2018 were enrolled. The medical records were retrospective reviewed. A Y-shaped incision was made on umbilicus. An operative telescope was used. The appendix and cecum were exteriorized through the wound. The base of appendix was wrapped by cecum with three unabsorbable stitches. The appendix was spatulated. The tip of the triangular umbilical flap was sutured to the tip of the spatulation. The both sides of the spatulation were sutured to both sides of the flap. A fr.8 feeding tube was left in the tunnel for one month postoperatively. A total of 15 patients were included, median age 5.0 years (2.9–10.7 years). Thirteen patients had anorectal malformations/cloaca, including 4 with spinal cord anomalies. Two patients had spina bifida. All patients presented with fecal incontinence; 7 of them had concomitant constipation. Transumbilical approach was successfully accomplished in fourteen patients. One patient required conversion to the three-port procedure and the stoma was eventually created at the right flank because of short appendical vessel length. One patient required tube placement under endoscopy assistance due to difficult intubation. Minor umbilical discharge less than once a month occurred in three patients; of these, spontaneous resolution was noted in one patient. Surgical revision was required in one patient because of appendix disruption. All patients were socially continent with antegrade enemas. The stoma and umbilical wound were hidden inside the umbilicus and virtually invisible. Transumbilical laparoscopy-assisted Malone procedure is effective in management of fecal incontinence and provides excellent wound outcomes.