Long-term outcomes of antegrade continence enema in children with chronic encopresis and incontinence: What is the optimal flush to use?
Purpose: Severe constipation and encopresis are significant problems in the pediatric population. Medical management succeeds in 50-70%; however, surgical considerations are necessary for the remainder such as the antegrade continence enema (ACE). The purpose of this study is to assess the long-term outcomes following the ACE procedure.
Methods: All patients undergoing an ACE over a 14-year period were included. Data on clinical conditions, treatments, and outcomes were collected. A successful outcome was defined as remaining clean with ≤ 1 accident per week. Comparative data were analyzed using the Fisher's exact test, Mann-Whitney U test, or Student's t test.
Results: There were 42 ACE patients, and overall, 79% had improvement in their bowel regimens. Encopresis rates decreased from 79 to 5% (P < 0.001). Admissions for cleanouts decreased from 52 to 19% (P = 0.003). All cases of Hirschsprung's, functional constipation and spina bifida were successful. Rates of success varied for other diseases such as slow-transit constipation (60%) and cerebral palsy (33%). A majority (85%) required a change in the enema composition for improvement.
Conclusion: In our study, ACE reduced soiling, constipation, and need for fecal disimpaction. Higher volume saline flushes used once a day was the optimal solution and most preferred option.
Level of evidence: Level 4 (retrospective case series or cohort).
Publication ( Name of Journal)
Pediatric Surgery International
Ayub, S. S.,
Larson, S. D.,
(2019). Long-term outcomes of antegrade continence enema in children with chronic encopresis and incontinence: What is the optimal flush to use?. Pediatric Surgery International, 35(4), 431-438.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_surg_paediatr/85