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Do preoperative factors predict success of antegrade continence enemas in children?
Jack P Vernamonti1, Caroline Hauck1, Erin P Santos1
1Section of Pediatric Surgery, University of Michigan, 1540 E. Hospital Drive, Floor 4 Reception B, Ann Arbor, MI 48109, USA.
Insights
Predicting success in pediatric Antegrade continent enemas (ACE) procedures is challenging. A pre-operative retrograde enema program may predict early success in children undergoing ACE for refractory constipation.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Clinical Outcomes Research
Background:
- Antegrade continent enemas (ACE) are a treatment for pediatric refractory constipation and encopresis.
- Predicting the success of ACE procedures can be difficult, impacting patient selection and counseling.
- Identifying preoperative factors can improve outcomes for children undergoing ACE.
Purpose of the Study:
- To identify preoperative factors that predict success in children undergoing ACE procedures.
- To establish expected timelines for success after ACE procedures.
- To aid in patient selection and family counseling for ACE.
Main Methods:
- Retrospective study of children undergoing cecostomy or appendicostomy for ACE (2015-2021).
- Analysis of underlying diagnosis, preoperative bowel regimen, and imaging.
- Evaluation of patient success at 3, 6, and 12 months post-procedure using statistical analysis.
Main Results:
- High success rates observed: 76% at 3 months, 86% at 6 months, and 87% at 12 months.
- A preoperative retrograde enema program predicted 3-month success (94% vs. 64%, p=0.03).
- Significant reduction in enteral medications post-procedure; other factors were not predictive.
Conclusions:
- ACE procedures demonstrate high success rates in children with refractory constipation.
- Preoperative retrograde enema may be a useful predictor of early ACE success.
- This study provides insights into expected timelines and predictive factors for ACE procedures.
Introduction:
Antegrade continent enemas (ACE) procedures are one treatment option in children with medically refractory constipation or encopresis and predicting success is difficult. We hypothesize that there are preoperative factors that can be identified to help with patient selection and family counseling.
Methods:
We conducted a retrospective study of children who underwent a cecostomy or appendicostomy for an ACE program between 2015 and 2021. Underlying diagnosis, pre-operative bowel regimen and imaging were analyzed. Patients were reviewed for success at 3-, 6- and 12-months post-procedure. Data was analyzed with Fisher's Exact, Kruskal-Wallis and logistic regression where applicable with significance defined as p < 0.05.
Results:
Forty-three children were identified; 28 were male, 15 were female, mean age at time of operation was 8 years old. 76% were considered successful at 3-months, 86% at 6-months, and 87% at 12-months post- procedure. Univariate analysis showed that a pre-ACE retrograde enema program predicted success at 3-months (94% vs. 64% p = 0.03) but no difference at 6- or 12-months. At one year after ACE procedure there was a significant reduction in number of enteral medications (2 to 0, p < 0.01) and 94% of patients were on one or fewer at one year follow-up. Age, gender, weight at time of operation, contrast enema, anorectal manometry and colonic transit time results were not predictive of outcomes.
Conclusion:
In this study, we characterized expected time to success in our population as well as identified use of a pre-operative retrograde enema program as a potential predictor of success at 3-months in children undergoing an ACE procedure.
Level Of Evidence:
IV.
Type Of Study:
Prognosis study.
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