title: 5 years after an ACE: what happens then?
abstract: OBJECTIVE
  Antegrade continence enema (ACE) revolutionised the lives of children with chronic constipation and soiling. Parents often ask how long the ACE will be required. We looked at our patients 5 years after ACE formation to answer the question.
  
  
  METHODS
  We reviewed clinical notes of all patients undergoing ACE procedure during January 1990 to December 2010. Only patients with >5 years follow-up were included. Data are given as median (range).
  
  
  RESULTS
  133 patients were included with >5 years of follow-up. Primary pathology was anorectal anomaly (ARA) 64 (48%); spinal dysraphism (SD) 40 (30%); functional constipation (FC) 14 (10%); Hirschsprung's Disease (HD) 10 (8%) and others 5 (4%). Median follow-up was 7 years (5-17 years). Overall 74% still use their ACE; whilst 26% no longer access their stoma, of whom 47% recovered normal colonic function. 50% of HD patient recover colonic function. FC has the highest failure rate at 21%.
  
  
  CONCLUSIONS
  Overall 86% achieved excellent clinical outcome with 74% of patient still using their ACE at 5 years. HD has the highest recovery rate of 50%. FC has a more unreliable clinical outcome with 21% recovered colonic function and 21% failed. Outcome varied dependent on the background diagnosis.
authors.affiliation: Department of Paediatric Surgery, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK. clara.chong@doctors.net.uk.
authors.forename: Clara
authors.initials: C
authors.lastname: Chong
authors.affiliation: Department of Paediatric Urology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Featherstone
authors.affiliation: Department of Paediatric Urology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
authors.forename: Shazia
authors.initials: S
authors.lastname: Sharif
authors.affiliation: Department of Paediatric Urology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
authors.forename: Abraham
authors.initials: A
authors.lastname: Cherian
authors.affiliation: Department of Paediatric Urology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Cuckow
authors.affiliation: Department of Paediatric Urology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
authors.forename: Imran
authors.initials: I
authors.lastname: Mushtaq
authors.affiliation: Department of Paediatric Surgery, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
authors.forename: Paolo
authors.initials: P
authors.lastname: De Coppi
authors.affiliation: Department of Paediatric Surgery, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Cross
authors.affiliation: Department of Paediatric Surgery, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
authors.forename: Joseph
authors.initials: J
authors.lastname: Curry
mesh_terms: D000293:Adolescent; D000071056:Anorectal Malformations / Q000150:complications / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003248:Constipation / Q000209:etiology / Q000601:surgery* / Q000628:therapy; D004733:Enema / Q000379:methods*; D004766:Enterostomy / Q000379:methods; D005242:Fecal Incontinence / Q000209:etiology / Q000601:surgery* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006627:Hirschsprung Disease / Q000150:complications / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D016135:Spinal Dysraphism / Q000150:complications / Q000601:surgery; D054047:Surgical Stomas; D016896:Treatment Outcome
keywords: ACE; Antegrade continence enema; Constipation; Outcome
references.citation: J Pediatr Surg. 2005 Dec;40(12):1935-40
references.pmid: 16338323
references.citation: Lancet. 1990 Nov 17;336(8725):1217-8
references.pmid: 1978072
references.citation: J Urol. 2002 Oct;168(4 Pt 1):1537-40; discussion 1540
references.pmid: 12352454
references.citation: Pediatr Surg Int. 2014 Nov;30(11):1135-41
references.pmid: 25287377
references.citation: J Pediatr Surg. 2013 Oct;48(10):2128-33
references.pmid: 24094968
references.citation: Am J Gastroenterol. 2000 Jul;95(7):1759-64
references.pmid: 10925981
references.citation: J Pediatr Surg. 2014 Sep;49(9):1405-8
references.pmid: 25148747
references.citation: BJU Int. 2002 Aug;90(3):240-3
references.pmid: 12133058
references.citation: Neurogastroenterol Motil. 2013 Feb;25(2):140-e81
references.pmid: 23035840
references.citation: J Pediatr Surg. 1998 Jan;33(1):133-7
references.pmid: 9473119
references.citation: J Pediatr. 2012 Oct;161(4):700-4
references.pmid: 22683036
references.citation: J Pediatr Surg. 2011 Jun;46(6):1236-42
references.pmid: 21683229
references.citation: Pediatr Surg Int. 2014 Jul;30(7):715-22
references.pmid: 24874343
references.citation: Biomed Res Int. 2013;2013:297084
references.pmid: 24175287
references.citation: J Pediatr Surg. 1999 Feb;34(2):338-40
references.pmid: 10052818
references.citation: Pediatr Surg Int. 2008 Jun;24(6):685-8
references.pmid: 18408942
references.citation: Eur J Pediatr Surg. 2014 Feb;24(1):113-6
references.pmid: 24443094
references.citation: J Pediatr Gastroenterol Nutr. 2011 May;52(5):574-80
references.pmid: 21502828
references.citation: J Pediatr Surg. 1995 Jan;30(1):68-71
references.pmid: 7722834
references.citation: J Pediatr Surg. 1998 Jan;33(1):138-41
references.pmid: 9473120
references.citation: Br J Surg. 1998 Jul;85(7):980-2
references.pmid: 9692578
references.citation: J Pediatr Surg. 2009 Feb;44(2):404-7
references.pmid: 19231544