Outcomes and Satisfaction in Pediatric Patients with Cecostomy Tube
Mark Bevill, BS1, Douglas Storm, MD1, Christopher Cooper, MD1, Angela Arlen, MD1, Kristine Bonnett, ARNP1, Cherly Baxter, CPNP2, Megan Schober, MD3.
1University of Iowa Hospitals and Clinics, Iowa City, IA, USA, 2Nationwide Children's Hospital, Columbus, OH, USA, 3William Beaumont Hospital, Royal Oaks, MI, USA.
Introduction: Patients with spina bifida and other spinal dysraphisms commonly suffer from fecal incontinence and constipation, which are known to have a large impact on psychosocial development and quality of life. Historically these patients have been managed with stool softeners, suppositories and/or retrograde/antegrade enemas. Currently, information regarding outcomes and satisfaction in children who have Chait cecostomy tubes is lacking. The aim of our study was to evaluate the effectiveness of Chait cecostomy tubes in the management of constipation in children with spinal dysraphisms. We hypothesized that patients with Chait tubes have improved constipation, fecal incontinence and quality of life as compared to pre-intervention and patients without Chait tubes.
Materials and Methods: An IRB approved questionnaire was completed by patients and/or their families during office visits at the University of Iowa or Nationwide Children’s Hospital during follow-up pediatric urology office visits. Two study groups completed the questionnaires: 1) Patients with neurogenic bowels who had a cecostomy tube in place (CT) and 2) Patients with neurogenic bowels with no cecostomy tube (NCT). The survey utilized Likert scaled and nonrated questions to assess demographics, bowel continence, and satisfaction. Data was analyzed using logistic regression and bivariate analysis. Likert responses were dichotomized into either positive or neutral/negative responses.
Results: A total of 86 patients completed the questionnaire. This included 53 CT patients and 33 NCT patients. The CT group had 25 males, and a mean age of 11 years (5-33). The NCT group had 13 males and a mean age of 13.6 years (3-42). 80% of the patients had spinal bifida.
CT patients rated the effectiveness of their cecostomy tube in managing their constipation significantly higher than the NCT group rated the effectiveness of their conventional bowel management methods (p<0.001). Compared to the NCT group, CT patients also had increased satisfaction with their current bowel management (p<0.01) and were more likely to recommend their current bowel management to a friend (p<0.01).
Within the CT group, 48% of patients had complete or near complete continence, 40% had partial fecal incontinence, while only 12% remained incontinent. In addition, of the CT respondents, 90% said their expectations were met, 88% were overall satisfied with the cecostomy tube, 88% would recommend it to a friend, and 92% would get the cecostomy tube again. In addition, hygiene, independence, and social confidence were significantly improved as compared to their baseline. Complications associated with the chait tube included granulation tissue that required treatment (60%) and pain with irrigation (24%).
Conclusions: CT patients reported significantly improved constipation management, fecal continence and improved quality of life as compared to NCT patients. Our pilot study demonstrates that the Chait cecostomy tube is a well-tolerated, effective means for treating
constipation and achieving fecal continence with minimal side effects in patients with neurogenic bowels.
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