Antegrade Continence Enemas in Children with Functional Constipation and Dyssynergic Defecation: Go or No Go?
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Read the article on jpedsurg.org ↗Article · Apr 2022 · 1 min read
In brief
In brief
Retrospective study of 39 pediatric patients with severe functional constipation treated with antegrade continence enemas (ACE) via Malone appendicostomy or cecostomy. Results showed 90% achieved fecal continence with daily flushes, including 86% of patients with dyssynergic defecation on manometry, supporting ACE as effective treatment for refractory constipation.
Written by the GCMD Library team from the article.
Objective
To assess outcomes of children with functional constipation after antegrade continence enemas (ACEs) and determine if pre-operative anorectal manometry (AMAN) findings, including dyssynergic defecation, are associated with outcomes.
Methods
A retrospective review of pediatric patients with functional constipation who received a Malone appendicostomy or cecostomy after failed medical management was conducted. Patients were included if they had AMAN data prior to their operation. Patients that underwent colonic resection were excluded. Demographics, clinical characteristics, manometry results, and post-ACE outcomes were obtained. Descriptive statistics were performed.
Results
Thirty-nine patients were identified with median age at ACE of 8.9 years (IQR: 7.2-12.6) and median follow-up of 2.5 years (IQR: 1.8-3.2 years). Twenty patients (51%) were female and most (35, 92%) were White. All patients had severe constipation prior to ACE and 59% had fecal incontinence. Thirty-four patients (87%) received a Malone and 5 (13%) received a cecostomy. Post-ACE, 35 (90%) were clean with daily flushes and 6 (15%) eventually successfully transitioned to laxatives only. Awake AMAN and balloon expulsion test were performed in 15 patients, with 14 (93%) displaying evidence of dyssynergic defecation. Twelve of 14 of patients (86%) with dyssynergia were clean with ACE at follow-up. Due to the majority of patients being clean post-ACE, there was limited power to detect predictors of poor outcomes.
Conclusions
ACEs are successful treatment options for patients with severe constipation and fecal incontinence, including those with dyssynergic defecation. Larger studies are needed to identify factors predictive of poor outcomes.