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Antegrade continence enema and its application in Africa

B Banieghbal1, M R Davies

  • 1Division of Paediatric Surgery, CH Baragwanath Hospital, Witwatersrand University, Johannesburg, Republic of South Africa.

Journal of Pediatric Surgery
|April 22, 1999
PubMed

Insights

The antegrade continent enema (ACE) procedure is effective for treating fecal incontinence in children in resource-limited settings. This salvage surgery offers a viable solution for managing complex cases in disadvantaged communities.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Public Health

Background:

  • The antegrade continent enema (ACE) procedure is a recognized salvage treatment for intractable constipation and fecal incontinence post-anorectal malformation surgery.
  • Previous reports on ACE procedures are predominantly from developed nations, limiting data from resource-constrained areas.

Purpose of the Study:

  • To evaluate the feasibility and efficacy of the antegrade continent enema (ACE) procedure in incontinent children from a low socioeconomic background in South Africa.
  • To assess the applicability of the ACE procedure in disadvantaged communities.

Main Methods:

  • Four ACE procedures were performed on incontinent children belonging to a low socioeconomic group.
  • Patients were managed with water washouts for hygiene, initiated one week post-operation.

Main Results:

  • The study included three patients with prior anorectal malformation surgery and one with intractable encopresis.
  • All patients achieved cleanliness using only water washouts, demonstrating the procedure's effectiveness with minimal intervention.

Conclusions:

  • The antegrade continent enema (ACE) procedure is readily implementable in African disadvantaged communities, requiring only minimal, supportive supervision.
  • The authors recommend its adoption by pediatric surgeons for children with severe constipation or incontinence after conservative treatment fails.
  • This study marks the first report of the ACE procedure being utilized for encopretic children.
Abstract

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