Published in:
01-11-2014 | Original Article
Antegrade continence enema (ACE): predictors of outcome in 111 patients
Published in: Pediatric Surgery International | Issue 11/2014
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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.