| Percutaneous
Cecostomy Return to HomePage |
| Patients and Families : Frequently Asked Questions |
What do you mean by "minimally invasive" when you talk about the procedure? The procedure is called minimally invasive because it is NOT a large, complex, long procedure and is done under image guidance (ie we can see what we are doing inside the body using ultrasound and flouroscopy). Because we use image guidance in our procedures, we can minimize the size of any hole to the size of a catheter. As a result, we minimize the impact of the procedure on the patient. Complication rates go down, and patient satisfaction increases dramatically. Return to Top of PageWhat exactly is the cecostomy catheter used for? Once the catheter is placed in the cecum it allows the introduction of small volume solution usually phosphate followed by saline. This is done while sitting on a toilet, because the bowels are quickly emptied. The next "treatment" is given when needed, usually 2-3 days. The initial catheter is changed to a small low profile "trapdoor" catheter after about 6 weeks. Return to Top of PageIs the catheter in place all the time? Yes, the initial catheter is 8 french in size. After 6 weeks this catheter is exchanged for the Chait Trapdoor catheter, which is extremely small, hidden below underwear or even covered by a bandaid. The catheters should only be removed when they are being exchanged, and when the cecostomy is no longer needed. Return to Top of PageIs the catheter used to drain (colostomy)? No, the catheter is in place for the administration of the antegrade enemas, which allow for predictable and reliable emptying of the colon, so there is no drainage bag. Return to Top of PageIs the tube noticeable on the outside of the body? The trapdoor is extremely small and is either hidden below underwear or is so small that a bandaid covers it. Check the website, there are pictures under "Health Care Providers > Follow-Up" Return to Top of PageHow long is the hospital stay? For the initial procedure, insertion of the temporary c-tube, patients are usually admitted for 2days. 6 weeks later, when the original tube is exchanged for the Chait Trapdoor, which takes 5minutes as an outpatient. Return to Top of PageHow safe is the procedure? From our experience since July 1994, after performing 147 procedures, we can comfortably say that it is very safe, but as with any procedure there are small risks. The most important is infection. That is why we give antibiotics, however because the procedure is so quick and the initial catheter so small we have had only one patient who developed an abscess requiring further antibiotics. Return to Top of PageAre their any side effects? Only good ones, like increased independence, better self esteem, etc. Return to Top of PageWhat happens if I regain bowel control or do not want the catheter anymore? The catheter is removed (by anyone) and the hole closes within a few days. Return to Top of PageWhere is the surgery done? We do the procedure at The Hospital for Sick Children in Toronto. I know that it is possible for interprovincial patient care. Interventional Radiologists around the world are now learning the procedure. Return to Top of PageIs this procedure done in the United States? Yes, now that the Chait Trapdoor catheter is FDA approved, the procedure is gaining popularity and there are Health Centres that are doing the procedure. Return to Top of PageWhat about coming to Toronto for the procedure? We have had several patients come from other provinces and the United States for the procedure. I can get you thier email and you can contact them. Return to Top of PageCan you recommend other online resources? See the Cook Patient Guide at http://www.cookgroup.com . They can send you a copy. Return to Top of PageShould I let our doctors know that we have been giving this option some consideration and see what the feedback is from them? You speak to as many people to make yourself comfortable. I would like to know what their responses are. Return to Top of PageHow many of these procedures have been performed? I have done over 140 procedures since June 94, so we have a long follow up. Return to Top of PageOnce the tube is placed, will she need to keep the cecostomy for the rest of her life, or could the catheter be permanently removed? If at any stage she does not require the tube it can easily be removed, even by you and the small hole closes in a few days. Return to Top of PageHow often does the Trapdoor catheter have to be changed? The Trapdoor catheter should be exchanged every 12-18 months. The procedure takes just a few minutes, and the patient goes home right after.. Return to Top of PageMy child has a bowel movement once a week stimulated by Senacot. What are the long-term effects of infrequent bowel movements? A bowel movement once a week is not nearly sufficient. Your child's bowels should (must) work once a day and softly - with or without help. You are not giving him/her enough Senocot. The long-term effect of infrequent bowel movements is a dilated, stretched, atonic colon and rectum from the huge amount of hard impacted stool. This stretches the bowel to a point of no return, non-function and an inability to expel the stool therein. We live in the US and have Blue Cross / Blue Shields coverage. Have they approved coverage for this procedure?
What is the coverage under the Spina Bifida / Agent Orange Benefit Act? Please see SBAA webpage Would there be a special diet after the procedure? What about foods that might cause gas or diarrhea, would that be a problem?
How many people 18 years or older have had this procedure?
I am already independant (I live on my own). How easy would it be to do the enemas myself?
I didn't read much about patients with Hirschsprung's disease. Do you not place them in these kids? Hirschsprung's surgery is sphincter-saving and all these infants and children should be continent after their surgery. If they are incontinent, the sphincter muscles were compromised at the operation, or the child has overflow incontinence secondary to constipation. The diagnosis is made by a history and rectal examination; if the sphincter feels normal, they should not and must not have a cecostomy tube. |