Review ArticleMalone appendicostomy versus cecostomy tube insertion for children with intractable constipation: A systematic review and meta-analysis
Section snippets
Study design
We conducted a systematic review and meta-analysis of children with functional and pathologic causes of intractable constipation refractory to maximal medical management. Our intervention and comparison groups were those treated with Malone appendicostomy versus cecostomy tube insertion. Our primary outcomes were continence post-procedure and quality of life. Secondary outcomes included adverse events and complications. Our study design was registered with the International Prospective Register
Search results
An overview of our search results is depicted in Fig. 1 [25]. Two hundred and thirteen studies were identified from the structured search of databases and an additional 16 records from our review of the grey literature. After removal of duplicates, 139 studies underwent title and abstract review. Studies were excluded for using a technique that was neither Malone appendicostomy nor cecostomy (n = 28), non-comparative design (n = 87), non-pediatric participants (n = 11), no surgical technique studied
Discussion
This study found no significant differences between Malone appendicostomy and cecostomy tube insertion in terms of achieving fecal continence. We were concerned to see that children who underwent Malone appendicostomy were more likely to require additional surgery. This is probably because the Malone procedure is associated with increased risk of stomal stenosis, leading to higher rates of surgical revision or conversion to cecostomy. Another possibility is that some of the children who
Acknowledgements
We would like to thank Andrea McLellan for her assistance with developing and executing the search strategy.
Conflicts of interest
The authors have no conflicts of interest to report.
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