title: Managing fecal incontinence in patients with myelomeningocele in Sub-Saharan Africa: Role of antegrade continence enema (ACE).
abstract: BACKGROUND
  Neural tube defects (NTDs) are among the major causes of sphincter dysfunctions. Fecal incontinence (FI) because of myelomeningocele (MMC) leads to problems with social acceptability and decreased quality of life (QOL), life satisfaction in addition to other morbidities. This is a report of experience with antegrade continence enema (ACE) in the management of FI in patients with MMC in an African set-up.
  
  
  METHODS
  A retrospective review of 23 children and young adults with FI because of MMC managed with ACE from October 2008 to September 2015 from African Specialist Hospital. The clinical outcomes have been analyzed.
  
  
  RESULTS
  From October 2008 to September 2015, a total of thirty-two n=32 patients underwent ACE procedure after repair of MMC associated with FI. Available data of 23 (71.87%) patients were reviewed retrospectively. Mean age at which ACE was created was 6.43±3.83years, range (3.5-17.8) years, median 5years. Follow-up after ACE creation was (0.5-6.9) years, median 2.6years. There were full continence in 13 (56.52%), partial continence in 8 (34.78%) and failure in 2 (8.69%). There were 16 (69.56%) complications and 4 (17.39%) minor post ACE surgery revisions. Mean PedQOL(™)score before ACE and then 5, 10, and 15months after ACE were 47.86±13.83, range (20.4-66.0) vs 88.34±7.11, range (77.9-98.6); p=0.000, 88.9±6.44 range (76.9-98.5); p=0.000, 89.01±6.50, range (76.9-98.88) p=0.000 respectively. Mean parental/caregiver satisfaction score for 15 (65.21%) patients aged 6years and below using modified visual analogue scale (VAS) 1 to 10 before ACE and after were 3.06±0.79, range (2-4), median 3 vs 8.0±1.30, range (5-10), median 8; (p=0.000) while 8 (34.78%) patients aged above 6years were able to assess their satisfactions score before and after ACE creation with mean of 1.75±0.70, range (1-3), median 2 vs 7.75±1.03, range (6-9) median 8; (p=0.000).
  
  
  CONCLUSIONS
  ACE has satisfactory outcomes in an African set-up in patients with MMC associated with FI. Multidisciplinary approach to neurogenic FI should be encouraged in such set-ups.
authors.affiliation: Children Surgery Unit, Department of Surgery, Murtala Muhammad Specialist Hospital, Kano, Nigeria. Electronic address: zarenawa1@yahoo.com.
authors.forename: Musa
authors.initials: M
authors.lastname: Ibrahim
authors.affiliation: Department of Neurosurgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria.
authors.forename: Nasiru Jinjiri
authors.initials: NJ
authors.lastname: Ismail
authors.affiliation: Department of Neurosurgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria.
authors.forename: Mohammad Aminu
authors.initials: MA
authors.lastname: Mohammad
authors.affiliation: Department of Neurosurgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria.
authors.forename: Hassan
authors.initials: H
authors.lastname: Ismail
authors.affiliation: Department of Surgery, Aminu Kano Teaching Hospital, Kano State, Nigeria.
authors.forename: Misbahu Haruna
authors.initials: MH
authors.lastname: Ahmed
authors.affiliation: Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria.
authors.forename: Owolabi Lukman
authors.initials: OL
authors.lastname: Femi
authors.affiliation: Department of Radiology, Aminu Kano Teaching Hospital, Kano, Nigeria.
authors.forename: Mohammed Abba
authors.initials: MA
authors.lastname: Suwaid
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004733:Enema / Q000379:methods*; D005242:Fecal Incontinence / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008591:Meningomyelocele / Q000150:complications*; D009549:Nigeria; D011788:Quality of Life; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Antegrade continence enema (ACE); Fecal incontinence; Myelomeningocele; Neural tube defects