title: After the honeymoon--medium-term outcome of antegrade continence enema procedure.
abstract: OBJECTIVE
  The aim of this study was to determine medium-term outcomes of the antegrade continence enema (ACE) procedure.
  
  
  METHODS
  A retrospective casenote review plus telephone questionnaire was conducted. The study was performed at a regional paediatric surgical centre. The subjects were consecutive children undergoing the ACE procedure over a 5 year period. Main outcome measures were use of the ACE; reversal rates; complications, ease of use, effectiveness, and satisfaction scores. Data are expressed as median (range).
  
  
  RESULTS
  Thirty-two (52%) of 62 children undergoing the ACE procedure were girls. The age at the time of operation was 11.5 (3.8 to 17.6) years. Underlying diagnoses included spina bifida (n = 31), anorectal malformations (n = 15), slow-transit constipation (n = 9), Hirschsprung's disease (n = 2), sacral agenesis (n = 2), and trauma/tumour (n = 2). Median follow-up was 5.4 (3.25 to 8.25) years. Eleven of 62 (18%) children were no longer using the ACE (n = 5) or had it surgically reversed (n = 6; 14.1 +/- 9.3 months postprocedure). Reasons for disuse/reversal were lack of effectiveness (n = 4), complications (n = 2), noncompliance (n = 3), independent continence (n = 1), and pain (n = 1). Five (8%) children currently have a colostomy. Gender (P =.31; Fisher's Exact), age (Pearson), and underlying diagnoses (P =.07, Chi2) were not predictors of failure. Overall, stomal stenosis was the most common complication, affecting 26 of 62 (41%) children. Of 32 questionnaire respondents to linear scores, ease of use was rated as 2 (0 to 8, 0, very easy; 10, very difficult), discomfort on use as 3 (0 to 9; 0, no pain; 10, very painful), overall satisfaction as 9 (0 to 10; 0, completely dissatisfied; 10, completely satisfied). Eighty-four percent were completely continent or had soiling less than once a month. There was a significant correlation between the level of continence and satisfaction with the procedure (P =.04; Pearson).
  
  
  CONCLUSIONS
  The ACE procedure offers significant benefits to some children with incontinence or intractable constipation. However, it is not universally successful, and other continence promoting strategies may need to be considered.
authors.affiliation: Alder Hey Children's Hospital and University of Liverpool, Liverpool, England.
authors.forename: R
authors.initials: R
authors.lastname: Dey
authors.forename: C
authors.initials: C
authors.lastname: Ferguson
authors.forename: S E
authors.initials: SE
authors.lastname: Kenny
authors.forename: K R
authors.initials: KR
authors.lastname: Shankar
authors.forename: P
authors.initials: P
authors.lastname: Coldicutt
authors.forename: C T
authors.initials: CT
authors.lastname: Baillie
authors.forename: G L
authors.initials: GL
authors.lastname: Lamont
authors.forename: D A
authors.initials: DA
authors.lastname: Lloyd
authors.forename: P D
authors.initials: PD
authors.lastname: Losty
authors.forename: R R
authors.initials: RR
authors.lastname: Turnock
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D013505:Digestive System Surgical Procedures / Q000379:methods; D004733:Enema / Q000379:methods*; D005242:Fecal Incontinence / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome