Antegrade continence enemas in the treatment of slow-transit constipation*
Section snippets
Materials and methods
The study was undertaken within the Department of General Surgery, Royal Children's Hospital, Melbourne, Australia which is a referral center for children with intractable constipation. A list was compiled from hospital records of all children diagnosed with a neuronal anomaly of the colon, within the broad category of intestinal neuronal dysplasia (IND), on the basis of the following criteria: (1) History of chronic, intractable constipation with or without encopresis; (2) clinical findings of
Results
Of the 40 patients, 1 died of cardiac disease, and 6 failed to return the questionnaire. Thirty-three patients were assessed and found to have a follow-up range of 3 to 54 months (median, 18 months) and an age range of 5 to 17 years (median, 10 years). One child had IND in the colon proximal to aganglionosis and was excluded from the study because of abdominoperineal surgery.
Thirty-two patients remained for study with a male to female ratio of 19:13 and a mean age range of 11.1 ± 3.4 years.
Discussion
Since the ACE was first described by Malone et al7 in 1990, it has become increasingly popular worldwide for the management of fecal incontinence. Ten years of experience confirms the technique to be highly successful in achieving continence in children with neuropathic bowel.2, 3, 4, 5, 6 However, less successful outcomes were reported for functional constipation.4
This study is the first to focus on a large number of children with well-documented functional constipation and slow colonic
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2013, Journal of Pediatric SurgeryCitation Excerpt :The most commonly encountered complications in our patients were occasional soiling (33%), although significantly less often and of significantly less volume than prior to the MACE, leakage from the MACE (33%), and granulation tissue (33%). Others observed continued soiling in 6.4%–77% [10,13,14,16–19] and leakage from the MACE site in 10%–35% [13,14,20]. No studies have specifically commented on granulation tissue rates, a fairly commonly observed finding at stoma sites.
Functional problems and their medical management
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2012, Journal of Pediatric SurgeryCitation Excerpt :This is a retrospective review of the treatment options (appendicostomy [13-15] vs TES) taken by children having intractable chronic constipation in a single tertiary institution.
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Address reprint requests to Professor John M. Hutson, Department of General Surgery, Royal Children's Hospital, Parkville 3052, Victoria, Australia.