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Medium-Term Outcomes of Antegrade Continent Enema (ACE): Cairo University Specialized Pediatric Hospital (CUSPH)
Ahmed Adel Gabr1, Aly Shalaby1, Ahmed Elham Fares1
1Cairo University Specialized Pediatric Hospital, Cairo, Egypt.
Insights
Antegrade continence enema (ACE) effectively improves quality of life and fecal incontinence in children long-term. While complications like stenosis and prolapse can occur, families highly recommend ACE for managing fecal incontinence.
Area of Science:
- Pediatric Surgery
- Colorectal Surgery
- Gastroenterology
Background:
- Fecal incontinence (FI) significantly impacts children's quality of life (QOL).
- Antegrade continence enema (ACE) is a surgical option for managing complex fecal incontinence in pediatric patients.
Purpose of the Study:
- To evaluate the medium-term outcomes of Antegrade continence enema (ACE) in children diagnosed with fecal incontinence (FI).
Main Methods:
- Prospective study of 24 children (aged 6-12 years) with FI from December 2016 to January 2020.
- Follow-up duration ranged from 2 to 6 years, utilizing questionnaires to assess QOL, patient/parent satisfaction, and ACE efficacy.
- Patient cohort included various conditions such as anorectal malformations, Hirschsprung disease, and neural tube defects.
Main Results:
- Significant improvements observed in Quality of Life (QOL) scores (p < 0.05) and Fecal Incontinence Index (FII) (p < 0.05).
- Patients reported better bowel symptom control, including decision-making and reduced soiling.
- High parent satisfaction (median score 9/10) and recommendation rates for ACE, despite a wide range of irrigation volumes used.
Conclusions:
- Antegrade continence enema (ACE) is an effective medium-term solution for improving QOL, social activity, and continence in children with FI.
- Common complications included stenosis, stomal prolapse, and leakage.
- ACE-related mucosal prolapse emerged as a notable complication during medium-term follow-up.
Aim Of The Study:
To assess the medium-term outcomes of ACE in children with fecal incontinence (FI).
Method:
Eligible children were recruited from the colorectal clinic between December 2016 and January 2020 and were followed prospectively for 2-6 years. A series of questionnaires were used to assess QOL, patients and parent satisfaction, and to assess the outcomes of the ACE.
Result:
24 children aged 6-12 years (mean age 8.17 ± 1.95), including 18 males (75%) and 6 females (25% were studied. Cases included anorectal malformations (45.83%)., Hirschsprung disease (25%), neural tube defects (16.66%), sacrococcygeal teratoma (4.16%), and intractable pseudoincontinence (8.33%). QOL improved from (3) [3 -3] to (16) [16-16],p < 0.05. Fecal incontinence index showed significant improvement: 20 [20-20] versus 3 [0-4],p < 0.05. Bowel symptoms demonstrated improvement in the ability to decide when to pass stools and a decrease in soiling. Stooling survey showed lower scores representing better outcome. ACE questionnaire showed that the range of irrigation volumes used by parents is wide, and that all families recommend the ACE for children with similar condition. Postoperative complications were stenosis (16.66%), stomal prolapse (12.5%), leakage (4.16%), and false passage (4.16%). Satisfaction questionnaire showed a median score of 9 (range, 5-10).
Conclusion:
ACE is an effective method to keep the child with FI clean, more socially active, and with a better QOL and FII in the medium-term. The reported complications were stenosis, false passage, and leakage. ACE mucosa prolapse is a novel complication picked up on medium-term follow up.
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