Long-term outcomes of antegrade continence enema in children with chronic encopresis and incontinence: what is the optimal flush to use?
Pediatr Surg Int
; 35(4): 431-438, 2019 Apr.
Article
in En
| MEDLINE
| ID: mdl-30426223
ABSTRACT
PURPOSE:
Severe constipation and encopresis are significant problems in the pediatric population. Medical management succeeds in 50-70%; however, surgical considerations are necessary for the remainder such as the antegrade continence enema (ACE). The purpose of this study is to assess the long-term outcomes following the ACE procedure.METHODS:
All patients undergoing an ACE over a 14-year period were included. Data on clinical conditions, treatments, and outcomes were collected. A successful outcome was defined as remaining clean with ≤ 1 accident per week. Comparative data were analyzed using the Fisher's exact test, Mann-Whitney U test, or Student's t test.RESULTS:
There were 42 ACE patients, and overall, 79% had improvement in their bowel regimens. Encopresis rates decreased from 79 to 5% (P < 0.001). Admissions for cleanouts decreased from 52 to 19% (P = 0.003). All cases of Hirschsprung's, functional constipation and spina bifida were successful. Rates of success varied for other diseases such as slow-transit constipation (60%) and cerebral palsy (33%). A majority (85%) required a change in the enema composition for improvement.CONCLUSION:
In our study, ACE reduced soiling, constipation, and need for fecal disimpaction. Higher volume saline flushes used once a day was the optimal solution and most preferred option. LEVEL OF EVIDENCE Level 4 (retrospective case series or cohort).Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Encopresis
/
Enema
/
Fecal Incontinence
Type of study:
Observational_studies
/
Prognostic_studies
Limits:
Adolescent
/
Child
/
Child, preschool
/
Female
/
Humans
/
Male
Language:
En
Journal:
Pediatr Surg Int
Journal subject:
PEDIATRIA
Year:
2019
Document type:
Article
Affiliation country:
United States