Bowel dysfunction in spina bifida--an American experience with the ACE procedure

Fecal incontinence remains a detriment to improved quality of life in many patients with spina bifida. Previous methods of conservative management frequently prove to be inadequate, causing many patients to withdraw from the social mainstream. Recent descriptions of procedures to provide access to the proximal colon for antegrade colonic enemas (ACE procedure) have provided a new approach to managing fecal incontinence. We report here our experience with these procedures in 43 patients with spina bifida. The background, techniques and outcomes of these procedures are discussed and a plea is made to consider this approach in all patients who are hampered in their social or vocational progress because of neurogenic anorectal dysfunction.