Antegrade Continence Enema (ACE): Predictors of Outcome in 111 Patients

Overview

Journal Pediatr Surg Int

Specialties General Surgery
Pediatrics

Date 2014 Oct 8

PMID 25287377

Citations 6

Authors

S Basson

A Zani

S McDowell

E Athanasakos

S Cleeve

S Phelps

P Charlesworth

Affiliations

Soon will be listed here.

Abstract

Purpose: The antegrade continence enema (ACE) is used as a means of managing faecal incontinence and constipation with varying outcomes. We aim to evaluate our outcomes of ACEs and identify predictors of outcome.

Methods: A retrospective case-note review of patients ≤16 years of age undergoing an ACE (March 2000-September 2013) was carried out. Data collected included: patient demographics, functional outcomes and complications. Data are quoted as median (range) and compared using Mann-Whitney and Fisher's exact test. Univariate analysis was performed to identify predictors of successful outcomes. P < 0.05 is significant. Successful outcome = total continence/occasional leakage and failed outcome = regular soiling and/or constipation.

Results: 111 patients with complete data sets underwent an ACE [59% male, median age = 9.5 years (3.4-16 years)] and median follow-up = 48 months (4 months-11 years 4 months). Underlying diagnoses were idiopathic constipation (n = 68), anorectal malformation (n = 27), neuropathic bowel (n = 7), Hirschsprung disease (n = 5) and gastrointestinal dysmotility (n = 4). Social continence was achieved in 87/111 (78%). Fifteen percent of patients underwent reversal of ACE due to resolution of symptoms. There was no difference in outcomes related to diagnosis, gender, age or follow-up duration. Complication rate was 20.7% (23/111).

Conclusions: The ACE is safe and effective in the management of intractable constipation and soiling. No predictors of outcome were identified.

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References

Antao B, Ng J, Roberts J . Laparoscopic antegrade continence enema using a two-port technique. J Laparoendosc Adv Surg Tech A. 2006; 16(2):168-73. DOI: 10.1089/lap.2006.16.168. View

Curry J, Osborne A, Malone P . How to achieve a successful Malone antegrade continence enema. J Pediatr Surg. 1998; 33(1):138-41. DOI: 10.1016/s0022-3468(98)90381-5. View

Masadeh M, Krein M, Peterson J, Bauer M, Phearman L, Pitcher G . Outcome of antegrade continent enema (ACE) procedures in children and young adults. J Pediatr Surg. 2013; 48(10):2128-33. DOI: 10.1016/j.jpedsurg.2013.04.009. View

Aksnes G, Diseth T, Helseth A, Edwin B, Stange M, Aafos G . Appendicostomy for antegrade enema: effects on somatic and psychosocial functioning in children with myelomeningocele. Pediatrics. 2002; 109(3):484-9. DOI: 10.1542/peds.109.3.484. View

Rajindrajith S, Devanarayana N, Benninga M . Review article: faecal incontinence in children: epidemiology, pathophysiology, clinical evaluation and management. Aliment Pharmacol Ther. 2012; 37(1):37-48. DOI: 10.1111/apt.12103. View

Ginkel R, Reitsma J, Buller H, van Wijk M, Taminiau J, Benninga M . Childhood constipation: longitudinal follow-up beyond puberty. Gastroenterology. 2003; 125(2):357-63. DOI: 10.1016/s0016-5085(03)00888-6. View

Stenstrom P, Graneli C, Salo M, Hagelsteen K, Arnbjornsson E . Appendicostomy in preschool children with anorectal malformation: successful early bowel management with a high frequency of minor complications. Biomed Res Int. 2013; 2013:297084. PMC: 3794643. DOI: 10.1155/2013/297084. View

Yardley I, Pauniaho S, Baillie C, Turnock R, Coldicutt P, Lamont G . After the honeymoon comes divorce: long-term use of the antegrade continence enema procedure. J Pediatr Surg. 2009; 44(6):1274-6. DOI: 10.1016/j.jpedsurg.2009.02.030. View

Corbett P, Denny A, Dick K, Malone P, Griffin S, Stanton M . Peristeen integrated transanal irrigation system successfully treats faecal incontinence in children. J Pediatr Urol. 2014; 10(2):219-22. DOI: 10.1016/j.jpurol.2013.08.006. View

10.

Alenezi H, Alhazmi H, Trbay M, Khattab A, Neel K . Peristeen anal irrigation as a substitute for the MACE procedure in children who are in need of reconstructive bladder surgery. Can Urol Assoc J. 2014; 8(1-2):E12-5. PMC: 3896552. DOI: 10.5489/cuaj.1263. View

11.

Jaffray B . What happens to children with idiopathic constipation who receive an antegrade continent enema? An actuarial analysis of 80 consecutive cases. J Pediatr Surg. 2009; 44(2):404-7. DOI: 10.1016/j.jpedsurg.2008.10.097. View

12.

Karpman E, Das S, Kurzrock E . Laparoscopic antegrade continence enema (Malone) procedure: description and illustration of technique. J Endourol. 2002; 16(6):325-8; discussion 328. DOI: 10.1089/089277902760261310. View

13.

Procter E, Loader P . A 6-year follow-up study of chronic constipation and soiling in a specialist paediatric service. Child Care Health Dev. 2003; 29(2):103-9. DOI: 10.1046/j.1365-2214.2003.00319.x. View

14.

Curry J, Osborne A, Malone P . The MACE procedure: experience in the United Kingdom. J Pediatr Surg. 1999; 34(2):338-40. DOI: 10.1016/s0022-3468(99)90204-x. View

15.

Koivusalo A, Pakarinen M, Rintala R . Are cecal wrap and fixation necessary for antegrade colonic enema appendicostomy?. J Pediatr Surg. 2006; 41(2):323-6. DOI: 10.1016/j.jpedsurg.2005.11.007. View

16.

Peeraully M, Lopes J, Wright A, Davies B, Stewart R, Singh S . Experience of the MACE procedure at a regional pediatric surgical unit: a 15-year retrospective review. Eur J Pediatr Surg. 2014; 24(1):113-6. DOI: 10.1055/s-0033-1357502. View

17.

Athanasakos E, Kemal K, Malliwal R, Scott S, Williams N, Aziz Q . Clinical and psychosocial functioning in adolescents and young adults with anorectal malformations and chronic idiopathic constipation. Br J Surg. 2013; 100(6):832-9. DOI: 10.1002/bjs.9111. View

18.

Graf J, Strear C, Bratton B, Housley H, Jennings R, Harrison M . The antegrade continence enema procedure: a review of the literature. J Pediatr Surg. 1998; 33(8):1294-6. DOI: 10.1016/s0022-3468(98)90172-5. View

19.

Siddiqui A, Fishman S, Bauer S, Nurko S . Long-term follow-up of patients after antegrade continence enema procedure. J Pediatr Gastroenterol Nutr. 2011; 52(5):574-80. PMC: 3877620. DOI: 10.1097/MPG.0b013e3181ff6042. View

20.

Pacilli M, Pallot D, Andrews A, Downer A, Dale L, Willetts I . Use of Peristeen® transanal colonic irrigation for bowel management in children: a single-center experience. J Pediatr Surg. 2014; 49(2):269-72. DOI: 10.1016/j.jpedsurg.2013.11.036. View