title: Antegrade continence enema in the treatment of congenital fecal incontinence beyond childhood.
abstract: OBJECTIVE
  The role of antegrade continence enema for the treatment of congenital fecal incontinence in adult patients remains unclear.
  
  
  METHODS
  Twenty-seven patients, median age 19 (range, 17-43) years, with congenital fecal incontinence underwent surgery for antegrade continence enema and were prospectively followed up for functional outcome after a median of 25 (range, 3-117) months.
  
  
  RESULTS
  The diagnoses included myelodysplasia (n = 14), anorectal malformations (n = 6), and others (n = 7). Antegrade continence enema conduits included appendicostomy (n = 22) and cecal (n = 2), ileal (n = 2), and sigmoid (n = 1) tubes. Thirteen (48 percent) patients had complications. Eighteen (66 percent) patients became fully continent, six (23 percent) had minor, and three (11 percent) major soiling. Antegrade continence enema became unnecessary in three patients (11 percent). Treatment with antegrade continence enema failed in three cases. Of the 21 patients who continued with antegrade continence enema, 16 (76 percent) are fully continent, and bowel function and quality of life was improved in 15 (71 percent) and 13 (62 percent) patients, respectively. The scores of convenience (1 = easy, 5 = difficult) and overall satisfaction (1 = poor, 10 = excellent) were median 2 (range, 1-4) and 8 (range, 3-10).
  
  
  CONCLUSIONS
  Despite numerous complications and occasional treatment failures, 90 percent of adult patients with congenital fecal incontinence benefited from antegrade continence enema.
authors.affiliation: Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland. antti.koivusalo@hus.fi
authors.forename: A I
authors.initials: AI
authors.lastname: Koivusalo
authors.forename: M P
authors.initials: MP
authors.lastname: Pakarinen
authors.forename: S-L
authors.initials: SL
authors.lastname: Pauniaho
authors.forename: R J
authors.initials: RJ
authors.lastname: Rintala
mesh_terms: D000293:Adolescent; D000328:Adult; D001065:Appendix / Q000601:surgery*; D002404:Catheterization; D015331:Cohort Studies; D004733:Enema; D004766:Enterostomy; D005242:Fecal Incontinence / Q000151:congenital* / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D017060:Patient Satisfaction; D016896:Treatment Outcome