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Oral Presentation - 41
Assessment of efficacy, complications, and quality of life in patients undergoing antegrade continence enema (ACE) procedures
Samir Hasan, Meltem Erdoğdu Polat, Ülgen Çeltik, Ahmet Çelik, İbrahim Ulman, Orkan Ergün
Ege University Faculty of Medicine Hospital, Department of Pediatric Surgery, İzmir, Turkey
Purpose:
The study aimed to evaluate efficacy, complications, and quality of life in patients undergoing antegrade continence enema procedures in managing chronic constipation and fecal incontinence.
Patients and Methods:
The records of patients between 2000 and 2024 were retrospectively reviewed. Data on demographics, diagnoses, surgical techniques, complications, revision surgery, fecal continence status, and quality of life scores (KINDL) were collected from archives and telephone interviews. Statistical analyses were conducted using IBM SPSS Statistics 27.
Results:
A total of 68 patients (M/F: 43/25) were included. Median age of 9 ± 4.9 years. Diagnoses included meningomyelocele (36), anorectal malformations (26), Hirschsprung’s disease (3), sacrococcygeal teratoma (1), and chronic constipation (7). Twenty-one patients underwent laparoscopic surgery. An appendiceal conduit was used in 42 patients, and a cecal/colonic conduit in 26 patients (appendiceal stump lengthened in 16, cecal conduit in 7, transverse colonic conduit in 1 Descending colonic conduit in 2). Cecal imbrication was performed in 29, and the Mitrofanoff procedure in 40 patients. The mean follow-up was 92 ± 80 months overall, 90 ± 75 months for appendiceal conduits, and 26 ± 20 months for cecal/colonic conduits. Complications and the need for a second surgery are summarized in Table 1.
Fecal continence was achieved in 89% of patients during the follow-up period. And the mean total score of QoL was 72.7 ±15.8.
Conclusion:
The efficacy of ACE procedures in achieving fecal continence has been demonstrated, with certain complications. In patients without an appendix, a cecal tube may be a suitable alternative. An anti-reflux mechanism could be added to prevent stomal reflux. The total Qol score seems to be good in most patients.