What Happens Post-Malone? An Investigation of Long-Term Postoperative Management of Antegrade Continence Enemas

Ellen M Encisco; Ramiro Garza; Neil L McNinch; Carolyn Davis; Nelson G Rosen; Beth Rymeski; Jason S Frischer; Aaron P Garrison; Justin T Huntington

doi:10.1016/j.jpedsurg.2024.161958

What Happens Post-Malone? An Investigation of Long-Term Postoperative Management of Antegrade Continence Enemas

J Pediatr Surg. 2024 Sep 26:161958. doi: 10.1016/j.jpedsurg.2024.161958. Online ahead of print.

Authors

Ellen M Encisco¹, Ramiro Garza², Neil L McNinch³, Carolyn Davis⁴, Nelson G Rosen⁵, Beth Rymeski⁵, Jason S Frischer⁵, Aaron P Garrison⁵, Justin T Huntington⁶

Affiliations

¹ Department of Pediatric Surgery, Akron Children's Hospital, Akron, OH, USA; Colorectal Center, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
² The University of Akron, Akron, OH, USA.
³ Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, OH, USA.
⁴ Department of Pediatric Surgery, Akron Children's Hospital, Akron, OH, USA.
⁵ Colorectal Center, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
⁶ Department of Pediatric Surgery, Akron Children's Hospital, Akron, OH, USA. Electronic address: [email protected].

PMID: 39358084
DOI: 10.1016/j.jpedsurg.2024.161958

Abstract

Background: An option for medically refractory fecal incontinence and/or constipation is the antegrade continence enema (ACE). We investigated ACE usage and its perceptions, including whether patients were able to discontinue use of the appendicostomy/cecostomy tube.

Methods: Patients who underwent appendicostomy creation or cecostomy tube placement at two institutions between 2012 and 2021 were reviewed. Patients or parents/guardians were contacted for completion of a survey. Summary statistics for clinical data were tabulated and associations were evaluated with chi-square analysis.

Results: A total of 165 patients were included, including 92 (55.8%) males. Eighty-two (49.7%) surveys were completed. Most patients (51.5%) presented with fecal incontinence; 38 (23.3%) presented with constipation. More patients had a primary underlying diagnosis of anorectal malformation (39.4%), followed by functional constipation (21.2%), Hirschsprung disease (18.8%), and spinal malformation (17.6%). Thirty-six (21.8%) patients discontinued flushes by time of contact, with switch to laxatives being the most common reason (19%), followed by appendicostomy stricture/obstruction/closure (17%), switch to ileostomy/colostomy (17%), and patient preference (14%). There was no difference in patients' ability to stop using flushes based on underlying diagnosis (p = 0.31). The majority (84.1%) of respondents were "very likely" to recommend antegrade enemas to other children with similar diagnosis and 76.8% reported being "very satisfied" that the operation was done.

Conclusions: There remains a high degree of satisfaction with antegrade continence enemas for children with constipation and fecal incontinence; some children may be able to stop using antegrade enemas with varied mechanisms including patient/family weaning versus with assistance and laxative trials.

Type of study: Retrospective cohort study.

Level of evidence: III.

Keywords: Antegrade continence enema; Constipation; Fecal incontinence.