Eur J Pediatr Surg 2012; 22(01): 026-028
DOI: 10.1055/s-0031-1285874
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Effectiveness of the Antegrade Colonic Enema Stopper at Preventing Stomal Stenosis: Long-Term Follow-Up

H. Carnaghan
1  UCL Institute of Child Health, Paediatric Surgery Unit, London, United Kingdom
,
H. Johnson
2  Great Ormond Street Hospital, Paediatric Surgery Unit, London, United Kingdom
,
S. Eaton
1  UCL Institute of Child Health, Paediatric Surgery Unit, London, United Kingdom
,
P. de Coppi
1  UCL Institute of Child Health, Paediatric Surgery Unit, London, United Kingdom
2  Great Ormond Street Hospital, Paediatric Surgery Unit, London, United Kingdom
,
J. Curry
2  Great Ormond Street Hospital, Paediatric Surgery Unit, London, United Kingdom
,
M. Morova
2  Great Ormond Street Hospital, Paediatric Surgery Unit, London, United Kingdom
,
K. Cross
2  Great Ormond Street Hospital, Paediatric Surgery Unit, London, United Kingdom
,
D. Drake
2  Great Ormond Street Hospital, Paediatric Surgery Unit, London, United Kingdom
,
E. Kiely
2  Great Ormond Street Hospital, Paediatric Surgery Unit, London, United Kingdom
,
A. Pierro
1  UCL Institute of Child Health, Paediatric Surgery Unit, London, United Kingdom
2  Great Ormond Street Hospital, Paediatric Surgery Unit, London, United Kingdom
› Author Affiliations
Further Information

Publication History

14 May 2011

14 July 2011

Publication Date:
23 January 2012 (online)

Abstract

Aim of the Study Stomal stenosis is the commonest complication of the antegrade colonic enema (ACE) procedure, reportedly occurring in 25–55% of patients. As such, a simple ACE stopper device (a small silicone plug sited in the ACE conduit between catheterisations) was designed to prevent stenosis. We performed a long-term follow-up study to determine the effectiveness of the stopper device.

Methods A retrospective case note review was performed of all patients who successfully underwent a primary ACE procedure over an 8.5-year period (January 2002 to June 2010). The inclusion criteria were (i) a minimum of 6 months follow-up, (ii) simple appendicostomy, (iii) caecal/colonic flap. In all patients an ACE stopper was sited in the conduit for at least 4 months and removed only for catheterisation. Data are mean±SEM.

Main Results 38 children were included in our study. Mean age at surgery was 9.6±0.5 years. Surgery was performed in 22 patients for incontinence and in 16 for chronic constipation. 31 underwent an appendicostomy and 7 had a caecal/colonic flap; all received an ACE stopper. The mean follow-up was 2.6±0.3 years. Only 3 patients (8%) developed stomal stenosis. The first occurred 6 months postoperatively, resulting from an ACE stopper which was too small and consequently persistently fell out. This conduit required dilatation. The second occurred at 27 months secondary to a stomal infection and required surgical revision. The third occurred 8 months postoperatively for no obvious cause, and was treated with dilation. 1 patient experienced stomal leakage.

Conclusion The ACE stopper is a simple yet highly effective method of preventing stomal stenosis. We recommend using the stopper in all ACE patients.