Success of Antegrade Continence Enema (ACE) in Pediatric Patients with Impaired Fecal Control

Abstract

Introduction

We aimed to describe long-term outcome, treatment success, and complications of antegrade continence enema (ACE) procedures considering underlying etiologies and associated disorders.

Materials and Methods

Overall, 180 patients undergoing ACE procedure at our institution during 1997–2019 were included in this retrospective study. Treatment success was defined as patient staying clean.

Results

The main underlying etiologies included spina bifida (n = 65, 36%), anorectal malformations (n = 58, 32%), Hirschsprung disease (n = 25, 14%), and functional constipation (n = 7, 4%). The most common complications were stomal leakage (n = 39, 22%), stenosis (n = 38, 21%), infection (n = 35, 19%), and granuloma/mucosal prolapse of the stoma (n = 34, 19%), and 29% (n = 52) of the patients reported functional problems. Overall, 48% of the patients (n = 87) experienced at least one ACE-related complication. At the latest follow-up, 61% of the patients were using ACE (n = 110), of whom 86% stayed clean (n = 95). Overall, ACE treatment was successful in 81% of patients (n = 144), defined as being clean with ACE in current use or after discontinuing ACE treatment as unnecessary. In total, 31% of the patients had stopped using ACE as unnecessary (n = 45). Spina bifida patients were least likely to discontinue ACE usage (n = 9, 14%), followed by anorectal malformation patients (n = 17, 29%), while 32% of Hirschsprung patients (n = 8) and 71% of constipation patients (n = 5) discontinued ACE as unnecessary.

Conclusions

As previous studies have also shown, we demonstrated that ACE treatment can be successfully utilized in majority of children with impaired fecal control. Two-thirds of patients continued ACE treatment over 5 years of whom 86% patients were staying clean.

Keywords

ACE - antegrade continence enema - incontinence - constipation

Publication History

Received: 19 February 2025

Accepted: 01 July 2025

Accepted Manuscript online:
01 July 2025

Article published online:
15 July 2025

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