Fecal Incontinence: Cecostomy or appendicostomy?

Infographic · Nov 2020 · 1 min read

In brief

This systematic review of 2,086 pediatric patients compared cecostomy versus appendicostomy for fecal incontinence management. Cecostomy demonstrated significantly lower complication rates (16.6% vs 42.3%) and fewer revision surgeries, while both procedures achieved similar continence rates and quality of life improvements.

Cecostomy shows significantly lower complication rates than appendicostomy (16.6% vs 42.3%) for pediatric fecal incontinence management.
Both procedures achieve similar rates of fecal continence and quality of life improvement in children with chronic constipation.
Appendicostomy requires revision surgery 15% more often than cecostomy, suggesting lower long-term durability.
Patient and family satisfaction scores are equivalent between cecostomy and appendicostomy despite differing complication profiles.
Cecostomy may be preferred initial approach given lower morbidity, though both are effective antegrade continence enema options.

Written by the GCMD Library team from the infographic.

The infographic uses a red and gray color scheme with anatomical diagrams showing cecostomy (left) and appendicostomy (right) procedures on simplified bowel illustrations. Below the diagrams, four outcome metrics are displayed with icons and percentages, comparing the two procedures side-by-side. Study methodology details appear on the left side with document and patient icons.

Background: Few studies have directly compared between cecostomy and appendicostomy for the management of
fecal incontinence in pediatric population. This systematic review of the literature describes outcomes and complications following both procedures. We also reviewed studies reporting impact on quality of life and patient satisfaction.
Methods: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar were
searched for chronic constipation pediatric patients who underwent cecostomy or appendicostomy. Two reviewers
independently screened studies, extracted data, and assessed quality.
Results:An initial literature search retrieved 633 citations. After review of all abstracts, 40 studies were included in the
final analysis, assessing a total of 2086 patients. The overall rate of complications was lower in the cecostomy group
compared to the appendicostomy group (16.6% and 42.3%, respectively). Achievement of fecal continence and improvement in patient quality of life were found to be similar in both groups, however the need for revision of surgery
was approximately 15% higher in the appendicostomy group.
Conclusion: Cecostomy has less post procedural complications, however rates of patient satisfaction and impact on
quality of life were similar following both procedures.

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