5 years after an ACE: what happens then?

Chong, Clara; Featherstone, Neil C.; Sharif, Shazia P.; Cherian, Abraham; Cuckow, Peter; Mushtaq, Imran; Coppi, Paolo De; Cross, Kate; Curry, Joseph I.

doi:10.1007/s00383-016-3857-6

Cited by 18 publications

(14 citation statements)

References 24 publications

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“…Dolejs et al reported 43% of patients were able to become independent from ACE flush with at least 24-month follow-ups [ 27 ]. Others had less promising outcomes, with 74% of patients still using their ACEs 5 years after the ACE procedure [ 28 ]. Rodriguez et al reported that in 64% of patients with constipation, the frequency of antegrade flushes could be decreased, while 28% successfully discontinued ACE administration at a 2-year (14–74 months) follow-up [ 11 ].…”

Section: Antegrade Continence Enemasmentioning

confidence: 99%

Pediatric Bowel Management Options and Organizational Aspects

et al. 2023

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A bowel management program (BMP) to treat fecal incontinence and severe constipation is utilized for patients with anorectal malformations, Hirschsprung disease, spinal anomalies, and functional constipation, decreasing the rate of emergency department visits, and hospital admissions. This review is part of a manuscript series and focuses on updates in the use of antegrade flushes for bowel management, as well as organizational aspects, collaborative approach, telemedicine, the importance of family education, and one-year outcomes of the bowel management program. Implementation of a multidisciplinary program involving physicians, nurses, advanced practice providers, coordinators, psychologists, and social workers leads to rapid center growth and enhances surgical referrals. Education of the families is crucial for postoperative outcomes, prevention, and early detection of complications, especially Hirschsprung-associated enterocolitis. Telemedicine can be proposed to patients with a defined anatomy and is associated with high parent satisfaction and decreased patient stress in comparison to in-person visits. The BMP has proved to be effective in all groups of colorectal patients at a 1- and 2-year follow-up with social continence achieved in 70–72% and 78% of patients, respectively, and an improvement in the patients’ quality of life. A transitional care to adult program is essential to maintain the same quality of care, and continuity of care and to achieve desired long-term outcomes as the patient reaches adult age.

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Section: Antegrade Continence Enemasmentioning

confidence: 99%

Pediatric Bowel Management Options and Organizational Aspects

et al. 2023

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“…In all, the majority of patients with true incontinence after pullthrough-due to either damage to the anal canal mucosa or to the muscular sphincter mechanism-will require enema therapy for social continence. Antegrade continence enemas offer a favorable quality of life, and for patients with HD in particular, some will obtain recovery of continence and ability to wean off of enemas (29). Another promising option for social continence is the Peristeen integrated transanal irrigation system (Coloplast, Denmark), which may allow highly compliant children to avoid a surgical antegrade enema access procedure while providing a favorable quality of life (30).…”

Section: The Soiling Patientmentioning

confidence: 99%

Reoperative techniques and management in Hirschsprung disease: a narrative review

Demehri

Dickie

2021

Transl Gastroenterol Hepatol

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The majority of children who undergo operative management for Hirschsprung disease have favorable results. A subset of patients, however, have long-term dysfunctional stooling, characterized by either frequent soiling or obstructive symptoms. The evaluation and management of a child with poor function after pull-through for Hirschsprung disease should be conducted by an experienced multidisciplinary team. A systematic workup is focused on detecting pathologic and anatomic causes of pullthrough dysfunction. This includes an exam under anesthesia, pathologic confirmation including a repeat biopsy, and a contrast enema, with additional studies depending on the suspected etiology. Obstructive symptoms may be due to technique-specific types of mechanical obstruction, histopathologic obstruction, or dysmotility-each of which may benefit from reoperative surgery. The causes of soiling symptoms include loss of the dentate line and damage to the anal sphincter, which generally do not benefit from revision of the pull-through, and pseudo-incontinence, which may reveal underlying obstruction. A thorough understanding of the types of complications associated with various pull-through techniques aids in the evaluation of a child with postoperative dysfunction. Treatment is specifically tailored to the patient, guided by the etiology of the patient's symptoms, with options ranging from bowel management to redo pull-through procedure. This review details the workup and management of patients with complications after pull-through, with a focus on the perioperative management and technical considerations for those who require reoperation.

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“…[8][9][10][11][12] It is interesting that some of the papers mention that a subset of patients stopped using their ACE because of restoration of normal bowel movements after a period of time flushing the colon. 10,13 This finding makes us think that chronic constipation can get better once withholding behavior or pelvic floor dyssynergia (they can train their pelvic floor when doing a flush to evacuate it) is improved, or that the underlying motility disorder can change over time when the colon is flushed daily. Some data exist that might support this theory.…”

Section: Ileostomymentioning

confidence: 99%

“…This suggests that colonic dysmotility may not only contribute to the etiology of FC but may also be a consequence of long-standing FC, possibly because of fecal stasis leading to suboptimal colonic motor function. 10,[13][14][15][16][17][18] Sacral Nerve Stimulation Sacral nerve stimulation (SNS) involves low-amplitude electrical stimulation of the sacral nerves. This effect can be administered via transcutaneous stimulation of the posterior tibial nerve, transabdominal stimulation, or via an electrode placed through the sacral foramen.…”

Section: Ileostomymentioning

confidence: 99%

“…or after successful antegrade irrigation. [13][14][15][16][17][18] Another factor which is under debate is whether antegrade access should accompany the resection, which may help with emptying in the short term before retrying the colon on a medical regimen. 36 There are still many reports describing major procedures to treat FC with "failure of medical management" in patients for whom an ACE was not tried first.…”

Section: Colonic Resectionmentioning

confidence: 99%

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Surgical Interventions for Functional Constipation: An Update

Vilanova-Sánchez

Levitt

2020

Eur J Pediatr Surg

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Chronic idiopathic constipation, also known as functional constipation, is defined as difficult and infrequent defecation without an identifiable organic cause. Medical management with laxatives is effective for the majority of constipated children. However there is a subset of patients who may need evaluation by a surgeon. As constipation progresses, it can lead to fecal retention and rectal and sigmoid distension, which impairs normal colorectal motility. Surgical interventions are influenced by the results of: a rectal biopsy, transit studies, the presence of megacolon/megarectum on contrast enema, the degree of soiling/incontinence, anorectal manometry findings, and colonic motility evaluation. In this review, we describe the different surgical options available (intestinal diversion, antegrade enemas, sacral nerve stimulation, colonic resections, and Botulinum toxin injection) and provide guidance on how to choose the best procedure for a given patient.

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5 years after an ACE: what happens then?

Abstract: Overall 86% achieved excellent clinical outcome with 74% of patient still using their ACE at 5 years. HD has the highest recovery rate of 50%. FC has a more unreliable clinical outcome with 21% recovered colonic function and 21% failed. Outcome varied dependent on the background diagnosis.

Cited by 18 publications

References 24 publications

Pediatric Bowel Management Options and Organizational Aspects

Pediatric Bowel Management Options and Organizational Aspects

Reoperative techniques and management in Hirschsprung disease: a narrative review

Surgical Interventions for Functional Constipation: An Update

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