title: A multicentre study of the management of disorders of defecation in patients with spina bifida.
abstract: Patients with spinal dysraphism may have severe constipation and faecal incontinence. The impact of antegrade colonic enema (ACE) in the management of patients with spina bifida (SB) is analysed. In a multicentre cross-sectional study, constipation, faecal incontinence and faecal management were described. Cases surgically treated were identified. Data were collected from 423 patients, of whom 230 did not use any manoeuvre or laxatives to assist evacuation. Conventional treatment was used in 193 patients, including digital extraction in 39%, retrograde enema in 21% and oral laxatives in 52%. For intractable constipation and overflow of faecal incontinence, 47 patients were treated with ACE, of whom 41 used the method at a mean time of interview of 4.1 +/- 1.9 years after ACE operation; six abandoned ACE for conventional management. With ACE, faecal continence was significantly improved compared with conventional management, and neither retrograde rectal enema nor digital extraction were required. The conduit was fashioned to the right colon in 32 cases and to the left colon in nine cases. This study provides information on a multicentre experience in bowel management in SB patients. Whatever the technique used, ACE has improved faecal status compared with conventional therapy.
authors.affiliation: Service de Chirurgie Infantile, Hôpital d'Enfants, CHU de Nancy, Vandoeuvre les Nancy, France. jl.lemelle@chu-nancy.fr
authors.forename: J L
authors.initials: JL
authors.lastname: Lemelle
authors.forename: F
authors.initials: F
authors.lastname: Guillemin
authors.forename: D
authors.initials: D
authors.lastname: Aubert
authors.forename: J M
authors.initials: JM
authors.lastname: Guys
authors.forename: H
authors.initials: H
authors.lastname: Lottmann
authors.forename: S
authors.initials: S
authors.lastname: Lortat-Jacob
authors.forename: J
authors.initials: J
authors.lastname: Moscovici
authors.forename: P
authors.initials: P
authors.lastname: Mouriquand
authors.forename: A
authors.initials: A
authors.lastname: Ruffion
authors.forename: M
authors.initials: M
authors.lastname: Schmitt
mesh_terms: D000293:Adolescent; D000328:Adult; D002400:Cathartics / Q000627:therapeutic use; D002648:Child; D003248:Constipation / Q000209:etiology / Q000628:therapy*; D003672:Defecation / Q000187:drug effects; D004733:Enema; D005242:Fecal Incontinence / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016135:Spinal Dysraphism / Q000150:complications* / Q000503:physiopathology
chemical_list: D002400:Cathartics