APSA PaperContemporary short- and long-term outcomes in patients with unremitting constipation and fecal incontinence treated with an antegrade continence enema

PurposeThe primary aim of this study is to determine the natural history of patients who undergo an antegrade continence enema (ACE) procedure including complications, functional results, and long-term outcomes.MethodsPatients aged 3-18 years who underwent an ACE procedure from 2008 to 2015 for unremitting constipation and fecal incontinence with at least thirty day follow-up were included. Patients with congenital anatomic disorders of the spine, rectum, and anus were excluded.ResultsA total of 93 patients were included in the analysis with an average age of 10 +/−4 years and follow-up of 26 +/−41 months. The ACE procedure was rapidly effective, with 99% of patients experiencing improvement at 1 month. At the end of follow-up, 83% of patients had normal bowel function, and 95% of patients noted improvement. Amongst patients with at least 24 months of follow-up (n = 51), 43% successfully stopped using their ACE at an average of 40 +/−27 months. Overall morbidity was 55%, mostly related to minor complications. However, 13% of patients required an additional operation.ConclusionThe ACE procedure is very successful in the treatment of unremitting constipation with fecal incontinence in appropriately selected patients.Level of evidenceLevel IV.