title: Antegrade continence enema (ACE): predictors of outcome in 111 patients.
abstract: OBJECTIVE
  The antegrade continence enema (ACE) is used as a means of managing faecal incontinence and constipation with varying outcomes. We aim to evaluate our outcomes of ACEs and identify predictors of outcome.
  
  
  METHODS
  A retrospective case-note review of patients ≤16 years of age undergoing an ACE (March 2000-September 2013) was carried out. Data collected included: patient demographics, functional outcomes and complications. Data are quoted as median (range) and compared using Mann-Whitney and Fisher's exact test. Univariate analysis was performed to identify predictors of successful outcomes. P < 0.05 is significant. Successful outcome = total continence/occasional leakage and failed outcome = regular soiling and/or constipation.
  
  
  RESULTS
  111 patients with complete data sets underwent an ACE [59% male, median age = 9.5 years (3.4-16 years)] and median follow-up = 48 months (4 months-11 years 4 months). Underlying diagnoses were idiopathic constipation (n = 68), anorectal malformation (n = 27), neuropathic bowel (n = 7), Hirschsprung disease (n = 5) and gastrointestinal dysmotility (n = 4). Social continence was achieved in 87/111 (78%). Fifteen percent of patients underwent reversal of ACE due to resolution of symptoms. There was no difference in outcomes related to diagnosis, gender, age or follow-up duration. Complication rate was 20.7% (23/111).
  
  
  CONCLUSIONS
  The ACE is safe and effective in the management of intractable constipation and soiling. No predictors of outcome were identified.
authors.affiliation: Department of Paediatric Surgery, The Royal London Hospital, Whitechapel, London, E1 1BB, UK, drsoniabasson@yahoo.co.uk.
authors.forename: S
authors.initials: S
authors.lastname: Basson
authors.forename: A
authors.initials: A
authors.lastname: Zani
authors.forename: S
authors.initials: S
authors.lastname: McDowell
authors.forename: E
authors.initials: E
authors.lastname: Athanasakos
authors.forename: S
authors.initials: S
authors.lastname: Cleeve
authors.forename: S
authors.initials: S
authors.lastname: Phelps
authors.forename: P
authors.initials: P
authors.lastname: Charlesworth
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000601:surgery / Q000628:therapy*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004733:Enema / Q000379:methods*; D005242:Fecal Incontinence / Q000601:surgery / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome