V7-06: Robotic conversion of Cecostomy tube to Malone antegrade continence enema (ACE), surgical technique.

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Introductions and Objectives
To our knowledge no previous report has described conversion of cecostomy tube or a Mic-key button (usually in the cecum) to an antegrade continence enema (ACE). Several reports have described the procedure in both open and laparoscopic fashion using the appendix, but it has never been described as a conversion procedure. In general ACE is preferred over cecostomy in achieving continence, decreasing stool leakage and being free of appliances. Several of our patients present to our clinic requesting a conversion from cecostomy tube to ACE

Methods
In this paper, we will describe surgical techniques in converting cecostomy to ACE laparoscopic robotic assisted. This approach appears to be simple and safe in achieving the above listed goals. It carries minimal morbidity to patient; quick recovery period and outcome have been satisfactory to this point in our small co-hort.

Results
In our small cohort we were able to perform this operation on three patients, 8-14 years of age. These patients all had spina bifida with neurogenic bladder and bowel as an underlining diagnosis. Two of these patients had bladder augmentation in the past for a neurogenic bladder. One patient had no other abdominal operations aside from cecostomy tube placement. All patients were discharged home on POD one. Two patients presented with superficial wound infections at the ACE site and were treated with antibiotics. No patients required revision of the stoma or the ACE up to this point. No stool leakage around the ACE was documented on their postoperative visits. Importantly, all three patients were happy with the outcome.

Conclusions
Conversion of cecostomy button to ACE robotically is a safe, simple operation without any major complications in this case series. General patient satisfaction is high with good fecal continence.

Funding: none