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

Lookup NU author(s): Bruce Jaffray

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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 9 years 7 months (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 5.5 years (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 5 years 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. (C) 2014 Elsevier Inc. All rights reserved.

Publication metadata

Author(s): Randall J, Coyne P, Jaffray B

Publication type: Article

Publication status: Published

Journal: Journal of Pediatric Surgery

Year: 2014

Volume: 49

Issue: 9

Pages: 1405-1408

Print publication date: 01/09/2014

Online publication date: 20/08/2014

Acceptance date: 27/02/2014

ISSN (print): 0022-3468

ISSN (electronic): 1531-5037

Publisher: W.B. Saunders Co.

URL: http://dx.doi.org/10.1016/j.jpedsurg.2014.02.090

DOI: 10.1016/j.jpedsurg.2014.02.090

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