Sunday, April 27, 2008

Antegrade continence enema (ACE): current practice.

Sinha CK, Grewal A, Ward HC. Antegrade continence enema (ACE): current practice. Pediatric Surgery International. 2008 Apr 12;

The purpose of this study was to assess current status of antegrade continence enema (ACE) procedure taking into account the recent improvement in the technique and outcome. Reviewing our record of 48 patients with ACE procedure performed between January 2002 and May 2007, we found that the underlying diagnoses were idiopathic constipation in 56%, anorectal malformation in 31%, spina bifida in 8% and Hirschsprung's disease in 4%. Mean age of operation was 10.7 years. Appendix was used as stoma in 73% of cases. Stomal stenosis requiring revision was seen in 6% of cases and continence was achieved in 92% of cases. A systematic search of database was performed for the same period. Twenty-four studies describing 676 patients were found. The mean age was 10 years and various sites used for ACE were, right side of abdomen in 71%, umbilicus in 15% and left side of abdomen in 14%. The incidence of open and laparoscopic procedures were 87 and 13%, respectively. Appendix was used for stoma in 76% procedures. Other operative modalities were retubularised colon, retubularised ileum, caecal button and caecostomy tube, etc. The mean volume of enema fluid used was 516 ml. The mean evacuation time was 42 min. Stomal stenosis requiring revision was seen in 13% of cases. Continence was achieved in 93% of cases. There has been significant improvement in the outcome during last 5 years in comparison to the outcome published in late 1990s. Advancements in techniques, better-trained stoma care nurses and better stoma appliances could have played major role in this success.

PMID: 18408942


Debbie Klumb said...

My daughter, age 23, spina bifida, L5, had ACE in 1998. Struggling greatly with solution - type and/or amount. Looking for advice - PLEASE. Used 15cc liquid bisacodyl, 15cc water, 30cc glycerin, totalling 60cc. Sometimes took all night for results. Sometimes caused tremendous discomfort and even nausea and vomitting. Used 1000mL saline solution. Sometimes did not work AT ALL. Sometimes bloated colon so much that she could not insert urinary cath. PLEASE ADVISE. We are open to trying something new. We are extremely flexible. HELP, PLEASE.

Debbie Klumb said...

If anyone has advice for me and my 23 year old daughter, my email is