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Antegrade continence enemas in the treatment of slow-transit constipation
J Marshall1, J M Hutson, N Anticich
1F. Douglas Stephens Surgical Research Laboratory, Murdoch Children's Research Institute, Department of General Surgery, Royal Children's Hospital, Melbourne, Australia.
Insights
The antegrade continence enema (ACE) procedure can improve well-being in children with slow transit constipation, but complications are common. Benefits are less pronounced than in patients with normal bowel motility.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Colorectal surgery
Background:
- Antegrade continence enema (ACE) is a treatment for anorectal dysfunction.
- Children with idiopathic constipation are typically not candidates for ACE.
- Slow transit constipation (STC) is a common condition in pediatric patients.
Purpose of the Study:
- To evaluate the outcomes of the antegrade continence enema (ACE) procedure in children with slow transit constipation (STC).
- To assess the efficacy and complications of ACE in a pediatric population with STC.
Main Methods:
- Retrospective review of 40 children with STC who underwent the ACE procedure.
- Assessment of outcomes through questionnaires and interviews with independent assessors.
- Follow-up ranged from 3 to 54 months (median 18 months) in 32 patients.
Main Results:
- Significant reduction in soiling (26/32 patients) and improvement in abdominal pain, appetite, and mood.
- Stomal complications were frequent, including stenosis (16/29) and mucus leak (20/29).
- Slow evacuation (12/29) and pain with enema (17/20) were also common.
Conclusions:
- The Malone appendicostomy (ACE) procedure offers benefits for children with STC.
- Improvements in well-being were observed, though less dramatic than in children with normal motility.
- Careful patient selection and management of complications are crucial for optimizing ACE outcomes in STC.
Background/Purpose:
Children with anorectal dysfunction can now be treated by antegrade continence enema (ACE), as described Malone et al. Those with idiopathic constipation, however, are not thought to be suitable for this treatment. Over 150 children attend the authors' department with proven slow transit constipation (mostly proven on nuclear transit/X-ray study), and the authors reviewed the outcome in the 40 of these who have had the ACE procedure. Families completed a questionnaire and attended interview with an independent assessor.
Methods:
Of the 40 patients, 32 patients were assessed. Follow-up ranged from 3 to 54 months (median, 18 months) and age ranged from 5 to 17 years (median age, 10 years). Three of 32 stomas were no longer in use. Frequency of soiling was reduced significantly in 20 patients, and a further 6 patients were clean (P <.01). Abdominal pains were relieved significantly (P <.05), and appetite and mood improved.
Results:
Stomal complications were frequent, (stenosis in 16 of 29, mucus leak in 20 of 29, fecal leak 3 of 29, catheter-related pain in 20 of 29). Slow evacuation (12 of 29) and pain with enema (17 of 20) also were common.
Conclusion:
Malone appendicostomy does improve the well being of patients with slow transit constipation, but the advantages are less dramatic than in children with normal motility.