Long-term outcomes of antegrade continence enema in children with chronic encopresis and incontinence: what is the optimal flush to use?

Suniah S. Ayub, Michelle Zeidan, Shawn D. Larson, Saleem Islam

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)

Abstract

Purpose: Severe constipation and encopresis are significant problems in the pediatric population. Medical management succeeds in 50–70%; however, surgical considerations are necessary for the remainder such as the antegrade continence enema (ACE). The purpose of this study is to assess the long-term outcomes following the ACE procedure. Methods: All patients undergoing an ACE over a 14-year period were included. Data on clinical conditions, treatments, and outcomes were collected. A successful outcome was defined as remaining clean with ≤ 1 accident per week. Comparative data were analyzed using the Fisher’s exact test, Mann–Whitney U test, or Student’s t test. Results: There were 42 ACE patients, and overall, 79% had improvement in their bowel regimens. Encopresis rates decreased from 79 to 5% (P < 0.001). Admissions for cleanouts decreased from 52 to 19% (P = 0.003). All cases of Hirschsprung’s, functional constipation and spina bifida were successful. Rates of success varied for other diseases such as slow-transit constipation (60%) and cerebral palsy (33%). A majority (85%) required a change in the enema composition for improvement. Conclusion: In our study, ACE reduced soiling, constipation, and need for fecal disimpaction. Higher volume saline flushes used once a day was the optimal solution and most preferred option. Level of evidence: Level 4 (retrospective case series or cohort).

Original languageEnglish
Pages (from-to)431-438
Number of pages8
JournalPediatric Surgery International
Volume35
Issue number4
DOIs
Publication statusPublished - 8 Apr 2019
Externally publishedYes

Keywords

  • Antegrade enema
  • Constipation
  • Encopresis
  • Hirschsprungs
  • Incontinence

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