title: Follow up of children undergoing antegrade continent enema: experience of over two hundred cases.
abstract: OBJECTIVE
  Antegrade continent enema (ACE) procedures have been used as a treatment of constipation and soiling. Little is known about the long-term results of these procedures, particularly as patients progress into adulthood. This study presents the long-term outcomes of ACE in children, with follow up into adulthood, over a fifteen-year period.
  
  
  METHODS
  A prospective database of all consecutive procedures performed from 1998 to 2013 by a single surgeon in a regional centre was analysed. Operative details and follow up by both paediatric and adult clinicians and stoma nurses were included.
  
  
  RESULTS
  During the study period 203 ACE procedures were performed in children with a median age of 9years 7months (3-17). Indications included chronic idiopathic constipation (CIC) resistant to medical treatment in 62% of cases, anorectal malformation in 18%, spinal cord abnormalities in 9% and Hirschprung's in 7%. After an average follow-up of 5.5years (0.5-15) 132 patients were still using their ACE. 113 (93%) regularly had a good result from the procedure, 8 a variable result and 1 poor. Soiling was prevented in 79 patients (75%), partially improved in 15 and persistent in 15. Over the study period 53 patients (26%) no longer used their ACE due to resolution of symptoms. In 32 of these patients the ACE was reversed at a median interval of 5years from formation (1-12). In 17 cases (8%) the procedure failed with significant symptoms persisting. Four of these patients were reversed and a further 11 went on to have other procedures including 5 restorative pouches and 4 stomas. Of the patients that no longer required their ACE the majority (81%) had a pre-operative diagnosis of CIC. Only 7% of ACE procedures performed for CIC failed compared to 26% for spinal cord abnormalities.
  
  
  CONCLUSIONS
  Many patients continue to use their ACE to good effect in long-term follow up. In this study over a quarter had resolution of their symptoms permitting reversal. This was more likely if they suffered idiopathic constipation.
authors.affiliation: Royal Victoria Infirmary, Queen Victoria Road, Newcastle Upon Tyne. Electronic address: jon_randall25@hotmail.com.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Randall
authors.affiliation: Royal Victoria Infirmary, Queen Victoria Road, Newcastle Upon Tyne. Electronic address: petercoyne@doctors.org.
authors.forename: Peter
authors.initials: P
authors.lastname: Coyne
authors.affiliation: Royal Victoria Infirmary, Queen Victoria Road, Newcastle Upon Tyne. Electronic address: bruce.jaffray@nuth.nhs.uk.
authors.forename: Bruce
authors.initials: B
authors.lastname: Jaffray
mesh_terms: D002648:Child; D002908:Chronic Disease; D003248:Constipation / Q000209:etiology* / Q000628:therapy*; D004733:Enema / Q000009:adverse effects / Q000379:methods*; D005242:Fecal Incontinence / Q000209:etiology / Q000628:therapy*; D005500:Follow-Up Studies; D006547:Hernia / Q000209:etiology; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology; D012002:Rectal Diseases / Q000209:etiology; D016896:Treatment Outcome
keywords: Antegrade; Children; Constipation; Continent; Enema; Incontinence