Outcomes and Complications of Chait Trapdoor Cecostomy in Pediatric Patients with Therapy-Resistant Constipation and Fecal Incontinence: A 14-Year Retrospective Study

Abstract

Aim of the Study To assess the incidence and types of complications and patient-reported outcomes in pediatric patients with therapy-resistant constipation or fecal incontinence (FI) without constipation who underwent Chait Trapdoor™ cecostomy (CTC). The findings contribute to the discussion on selecting the optimal antegrade continence (ACE) procedure for this population.

Materials and Methods A retrospective review was conducted on all pediatric patients with therapy-resistant constipation or FI without constipation who underwent a CTC procedure at our tertiary referral center between 2009 and 2023. Postoperative complications were classified using the Clavien-Madadi classification. At their most recent follow-up in 2023, patients reported satisfaction with their CTC.

Results The study included 62 children (median age 12 years [IQR 8–14; range 1–17], 42% male), with a median follow-up of 4 years (IQR 2–8, range 0–14). Underlying diagnoses were functional constipation (n = 39, 63%), spina bifida (n = 11, 18%), and anorectal malformations (n = 5, 8%). A total of 49/62 patients (79%) experienced 89 CTC-related complications. Minor complications (Clavien-Madadi I–II) affected 29 patients (47%) and most commonly included granulation. Major complications (Clavien-Madadi III–IV) requiring surgery occurred in 32% of patients. Despite these complications, 40/62 (65%) patients reported satisfaction with their CTC, as determined by partial or complete symptom resolution.

Conclusions Although complications were common, 65% of the patients reported satisfaction with their CTC. These findings emphasize the need for thorough patient selection, informed counseling on potential risks, and individualized management strategies to enhance outcomes.

Keywords

pediatrics - fecal incontinence - constipation - Chait Trapdoor cecostomy - antegrade continence enema

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