title: Antegrade continence enema in the treatment of obstructed defaecation with or without faecal incontinence.
abstract: BACKGROUND
  Obstructed defaecation and faecal incontinence are complex functional disorders that pose management challenges. In recent times, the antegrade continence enema (ACE) has been tried both as a primary procedure and as a final resort to avoid a colostomy in patients with a variety of functional problems. The purpose of this study was to evaluate the role of the ACE procedure as a treatment option for adult patients suffering from obstructed defaecation with or without faecal incontinence, some of whom also had slow transit constipation.
  
  
  METHODS
  Twenty female patients underwent ACE as an appendicostomy (65%) or caecostomy (35%). The median age was 44 years (range, 20-65 years). The indications were obstructed defaecation with faecal incontinence (65%) and obstructed defaecation alone (35%). Fifteen of these patients were followed for 3-51 months (median, 6 months). Cleveland continence score, bowel score and quality of life score were recorded pre- and postoperatively along with post-procedure complications.
  
  
  RESULTS
  Thirteen (65%) patients were satisfied with the outcome and recorded improvement in their scores while two (10%) remained the same and one (5%) was worse. This latter woman and another patient stopped using their ACE, whilst follow-up data was unavailable for three patients. Minor wound infections were noted in nine patients (45%), of whom one needed drainage of an abscess; the rest settled with antibiotics and dressings. Bowel and Cleveland continence scores improved postoperatively (p<0.001 and p=0.001, respectively) but SF36 scores did not. To date, no patient has had a colostomy following an ACE procedure.
  
  
  CONCLUSIONS
  Colostomies can be avoided in patients with obstructed defaecation. There is, however, a need to minimise wound infections which seem to be the most troublesome complication.
authors.affiliation: Colorectal Unit, Singleton Hospital, Swansea, UK. grahamrhirst@yahoo.co.uk
authors.forename: G R
authors.initials: GR
authors.lastname: Hirst
authors.forename: P J
authors.initials: PJ
authors.lastname: Arumugam
authors.forename: A J
authors.initials: AJ
authors.lastname: Watkins
authors.forename: P
authors.initials: P
authors.lastname: Mackey
authors.forename: A R
authors.initials: AR
authors.lastname: Morgan
authors.forename: N D
authors.initials: ND
authors.lastname: Carr
authors.forename: J
authors.initials: J
authors.lastname: Beynon
mesh_terms: D000328:Adult; D000368:Aged; D019072:Antibiotic Prophylaxis; D002431:Cecostomy / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D003248:Constipation / Q000150:complications* / Q000175:diagnosis; D003672:Defecation / Q000502:physiology; D005244:Fecal Impaction / Q000209:etiology / Q000601:surgery*; D005242:Fecal Incontinence; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008365:Manometry; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D007507:Therapeutic Irrigation / Q000379:methods; D016896:Treatment Outcome