title: Effectiveness of the antegrade colonic enema stopper at preventing stomal stenosis: long-term follow-up.
abstract: OBJECTIVE
  Stomal stenosis is the commonest complication of the antegrade colonic enema (ACE) procedure, reportedly occurring in 25-55% of patients. As such, a simple ACE stopper device (a small silicone plug sited in the ACE conduit between catheterisations) was designed to prevent stenosis. We performed a long-term follow-up study to determine the effectiveness of the stopper device.
  
  
  METHODS
  A retrospective case note review was performed of all patients who successfully underwent a primary ACE procedure over an 8.5-year period (January 2002 to June 2010). The inclusion criteria were (i) a minimum of 6 months follow-up, (ii) simple appendicostomy, (iii) caecal/colonic flap. In all patients an ACE stopper was sited in the conduit for at least 4 months and removed only for catheterisation. Data are mean±SEM.
  
  
  RESULTS
  38 children were included in our study. Mean age at surgery was 9.6±0.5 years. Surgery was performed in 22 patients for incontinence and in 16 for chronic constipation. 31 underwent an appendicostomy and 7 had a caecal/colonic flap; all received an ACE stopper. The mean follow-up was 2.6±0.3 years. Only 3 patients (8%) developed stomal stenosis. The first occurred 6 months postoperatively, resulting from an ACE stopper which was too small and consequently persistently fell out. This conduit required dilatation. The second occurred at 27 months secondary to a stomal infection and required surgical revision. The third occurred 8 months postoperatively for no obvious cause, and was treated with dilation. 1 patient experienced stomal leakage.
  
  
  CONCLUSIONS
  The ACE stopper is a simple yet highly effective method of preventing stomal stenosis. We recommend using the stopper in all ACE patients.
authors.affiliation: UCL Institute of Child Health, Paediatric Surgery Unit, London, UK.
authors.forename: H
authors.initials: H
authors.lastname: Carnaghan
authors.forename: H
authors.initials: H
authors.lastname: Johnson
authors.forename: S
authors.initials: S
authors.lastname: Eaton
authors.forename: P
authors.initials: P
authors.lastname: de Coppi
authors.forename: J
authors.initials: J
authors.lastname: Curry
authors.forename: M
authors.initials: M
authors.lastname: Morova
authors.forename: K
authors.initials: K
authors.lastname: Cross
authors.forename: D
authors.initials: D
authors.lastname: Drake
authors.forename: E
authors.initials: E
authors.lastname: Kiely
authors.forename: A
authors.initials: A
authors.lastname: Pierro
mesh_terms: D057868:Anastomotic Leak / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D002648:Child; D003125:Colostomy / Q000009:adverse effects; D003251:Constriction, Pathologic / Q000209:etiology / Q000517:prevention & control; D004733:Enema / Q000009:adverse effects* / Q000295:instrumentation*; D004867:Equipment Design; D005242:Fecal Incontinence / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013524:Surgical Flaps; D054047:Surgical Stomas