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. 2014 Sep;49(9):1405-8.
doi: 10.1016/j.jpedsurg.2014.02.090.

Follow up of children undergoing antegrade continent enema: experience of over two hundred cases

Jonathan Randall  1 , Peter Coyne  2 , Bruce Jaffray  3
Affiliations

Follow up of children undergoing antegrade continent enema: experience of over two hundred cases

Jonathan Randall et al. J Pediatr Surg. 2014 Sep.

Abstract

Purpose: Antegrade continent enema (ACE) procedures have been used as a treatment of constipation and soiling. Little is known about the long-term results of these procedures, particularly as patients progress into adulthood. This study presents the long-term outcomes of ACE in children, with follow up into adulthood, over a fifteen-year period.

Methods: A prospective database of all consecutive procedures performed from 1998 to 2013 by a single surgeon in a regional centre was analysed. Operative details and follow up by both paediatric and adult clinicians and stoma nurses were included.

Results: During the study period 203 ACE procedures were performed in children with a median age of 9years 7months (3-17). Indications included chronic idiopathic constipation (CIC) resistant to medical treatment in 62% of cases, anorectal malformation in 18%, spinal cord abnormalities in 9% and Hirschprung's in 7%. After an average follow-up of 5.5years (0.5-15) 132 patients were still using their ACE. 113 (93%) regularly had a good result from the procedure, 8 a variable result and 1 poor. Soiling was prevented in 79 patients (75%), partially improved in 15 and persistent in 15. Over the study period 53 patients (26%) no longer used their ACE due to resolution of symptoms. In 32 of these patients the ACE was reversed at a median interval of 5years from formation (1-12). In 17 cases (8%) the procedure failed with significant symptoms persisting. Four of these patients were reversed and a further 11 went on to have other procedures including 5 restorative pouches and 4 stomas. Of the patients that no longer required their ACE the majority (81%) had a pre-operative diagnosis of CIC. Only 7% of ACE procedures performed for CIC failed compared to 26% for spinal cord abnormalities.

Conclusion: Many patients continue to use their ACE to good effect in long-term follow up. In this study over a quarter had resolution of their symptoms permitting reversal. This was more likely if they suffered idiopathic constipation.

Keywords: Antegrade; Children; Constipation; Continent; Enema; Incontinence.

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