title: Long-term results of the antegrade continent enema procedure for constipation in adults.
abstract: OBJECTIVE
  The aim of this study was to evaluate the long-term results of the Antegrade Continent Enema (ACE) procedure for treating severe constipation in adults.
  
  
  METHODS
  Over 10 years 37 ACE conduits were created in 32 patients (median age 35 years, 26 women) with constipation caused by slow transit, obstructed defaecation or both. Conduits were created from the appendix (n = 20, 54%), ileum (n = 10, 27%), neoappendix caecostomy (n = 5, 14%) or colon (n = 2, 5%). Clinical records were retrospectively reviewed to determine outcome.
  
  
  RESULTS
  After a median follow up of 36 (range 13-140) months, 28 (88%) required at least one further procedure on a primary conduit, including reversal in 19 (59%). Five patients had a second conduit fashioned, two successfully. Conduit type and constipation cause did not significantly influence the rates of ACE reversal or major revision. Ileal conduits were associated with fewer minor revision procedures for stenosis (1 in 7 patients) than appendix conduits (21 in 20 patients). There was one (3%) serious complication. Satisfactory ACE function was ultimately achieved in 47% of patients, at last follow up. After ACE reversal, 9 (28%) patients underwent formation of an end stoma and 3 patients had a colectomy.
  
  
  CONCLUSIONS
  Revision procedures are common, but approximately half of patients can expect satisfactory long-term ACE function. ACE conduit reversal does not preclude subsequent alternative surgical strategies to treat this difficult condition.
authors.affiliation: Department of Colorectal Surgery, Hope Hospital, Salford, UK. nicholas.lees@virgin.net
authors.forename: N P
authors.initials: NP
authors.lastname: Lees
authors.forename: P
authors.initials: P
authors.lastname: Hodson
authors.forename: J
authors.initials: J
authors.lastname: Hill
authors.forename: R C
authors.initials: RC
authors.lastname: Pearson
authors.forename: I
authors.initials: I
authors.lastname: MacLennan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001065:Appendix / Q000601:surgery; D002431:Cecostomy / Q000379:methods; D015331:Cohort Studies; D003248:Constipation / Q000175:diagnosis* / Q000601:surgery*; D003672:Defecation / Q000502:physiology; D004733:Enema / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D054047:Surgical Stomas; D016896:Treatment Outcome