title: Early experience with the antegrade colonic enema stopper to reduce stomal stenosis.
abstract: BACKGROUND
  Since the initial description of the antegrade colonic enema (ACE) procedure, stomal stenosis has been recognized as its most common complication. We previously reported that 44% of our patients required a dilatation for stomal stenosis, with 22% requiring surgical revision. We present our findings with the use of an ACE stopper (Medicina, Adlington, Lancashire, UK) as a means of avoiding this problem.
  
  
  METHODS
  A retrospective review of the case notes of all patients who underwent an ACE procedure with a follow-up longer than 6 months was carried out over a 3-year period. Two weeks after the ACE procedure, an ACE stopper was sited in the conduit for at least 4 months and removed only for catheterization.
  
  
  RESULTS
  Fourteen patients underwent an ACE procedure, 12 of whom received it laparoscopically. All patients received the ACE stopper. The patients' median age at surgery was 10 years (range, 5-16 years). Diagnoses included spinal dysraphism (n = 6) and anorectal malformation (n = 4), with soiling as the presenting complaint among all patients. The patients' median follow-up was 12 months (range, 6-39 months). There was no stomal complication, and 13 patients reported a marked improvement in soiling.
  
  
  CONCLUSIONS
  The use of an ACE stopper has abolished stomal stenosis on short-term follow-up. We recommend the stopper as an adjunct to the overall management of concerned patients. Longer follow-up is required to establish the true effectiveness of this simple device.
authors.affiliation: Department of Pediatric Surgery, Great Ormond Street Hospital, London WC1N 3JH, UK.
authors.forename: Pedro Jose
authors.initials: PJ
authors.lastname: Lopez
authors.forename: Hutan
authors.initials: H
authors.lastname: Ashrafian
authors.forename: Simon A
authors.initials: SA
authors.lastname: Clarke
authors.forename: Helen
authors.initials: H
authors.lastname: Johnson
authors.forename: Edward M
authors.initials: EM
authors.lastname: Kiely
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003106:Colon / Q000473:pathology*; D003108:Colonic Diseases / Q000209:etiology / Q000517:prevention & control*; D003125:Colostomy / Q000295:instrumentation*; D003251:Constriction, Pathologic / Q000209:etiology; D004733:Enema / Q000295:instrumentation*; D005242:Fecal Incontinence / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D054047:Surgical Stomas / Q000009:adverse effects*