One-year outcomes for patients undergoing antegrade continence enema procedures without prior rectal enema therapy: A pediatric colorectal and pelvic learning consortium study

Purpose: Antegrade continence enemas (ACE) delivered through surgically placed channels help achieve social continence in children with colorectal disorders. Historically, a successful rectal enema program was required before ACE creation, but high-volume centers increasingly perform ACE upfront, particularly for patients intolerant of rectal enemas. This study describes a cohort of patients who underwent upfront ACE for bowel management within a multicenter consortium of high-volume pediatric colorectal centers, with 30-day and one-year outcomes. Methods: We retrospectively evaluated patients who underwent a primary ACE channel at institutions participating in a multicenter pediatric colorectal consortium (2017-2025), excluding those with a redo ACE or a pre-existing ostomy. Results: Among 171 patients who underwent upfront ACE (median age 7.0 years), diagnoses included anorectal malformation (54.4%), functional constipation (36.3%), and Hirschsprung disease (9.9%); approximately one-third had an associated psychiatric or neurodevelopmental diagnosis. Most had already failed oral laxative therapy (71.3% vs 37.6% of the 402 patients treated with rectal enemas before ACE). Complication rates were low at 30 days (6.4%) and one year (11.1%), comparable to those of the prior-enema cohort. At one year, 90.0% (117/130) were still using ACE flushes as their primary bowel management, and 6.4% (11/171) had discontinued flushes, none because of an inability to manage constipation or in