Antegrade Continence Enemas for Pediatric Functional Constipation: A Systematic Review

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Clinical Outcomes Research

Background:

• Functional constipation (FC) significantly impacts children's quality of life despite conservative treatments.
• Antegrade continence enema (ACE) surgery is considered for refractory pediatric FC.
• This review assesses ACE surgery outcomes in pediatric functional constipation.

Purpose of the Study:

• To systematically review the outcomes of Antegrade continence enema (ACE) surgery in children with functional constipation (FC).

Main Methods:

• Systematic review of 13 studies (477 children) published up to March 2024.
• Evaluated primary outcome: treatment success (defecation/incontinence frequency).
• Assessed secondary outcomes: ACE cessation, complications, HRQoL, and satisfaction; quality of evidence was evaluated.

Main Results:

• Treatment success rates for ACE surgery in pediatric FC varied widely (32%-100%).
• Complication rates ranged from 6% to 100%, with 0%-34% requiring surgical intervention.
• Improvements in health-related quality of life (HRQoL) and high patient/parent satisfaction were reported.

Conclusions:

• ACE surgery outcomes for pediatric functional constipation demonstrate significant variability in success and complication rates.
• There is a critical need for standardized definitions and treatment guidelines for ACE surgery in children.
• Further research should focus on establishing uniform protocols for ACE procedures in pediatric FC management.