The results of antegrade continence enema using a retubularized sigmoidostomy

Abstract

Left colonic antegrade continence enema (ACE) has been reported only as an alternative to right colonic ACE-the Malone appendicostomy and Monti retubularized ileostomy. This paper evaluated the advantages of left colonic ACE using a retubularized sigmoidostomy (RS) as an appropriate method for maintaining fecal continence and as a first-line surgical treatment for patients with fecal incontinence or intractable constipation. Ten patients underwent surgery between March 2002 and June 2003: seven with meningomyelocele, one with cloacal anomaly, one with anorectal malformation, and one with lipoma of the spine. An RS tube was fashioned and then implanted using a segment of the sigmoid colon and exteriorized through the umbilicus. An enema was done 10 days after surgery using only normal saline. The outcomes were assessed after adjusting to the appropriate enema regimen for the 10 cases. The mean duration of the enema was 23.0+/-8.4 min, with 250 ml (range 80-800) as the median volume of fluid used. The enema interval ranged from 1-3 days. No patient showed any abdominal discomfort or soiling episodes, with the exception of one who experienced daytime fecal staining, but this occurred less than once per month. The self-cosmesis for the umbilical stoma was satisfactory. The RS procedure provided excellent continence control, with a shortening of the enema duration, a lower fluid volume, and good cosmesis, and without any ACE-related abdominal pain. This procedure can be used as a first-choice surgical treatment for intractable constipation and fecal incontinence.

Left colonic antegrade continence enema: experience gained from 19 cases

“…Since that report, other authors have reported good results [9,10]. In this article, we present the clinical consequences in 19 patients who underwent left colonic antegrade continence enema (LACE) and an analysis of the treatment outcomes and complications.…”

Is the outcome of the left colon antegrade continence enema better than that of the right colon antegrade continence enema?

“…There have been numerous modified surgical procedures since the first report by Malone et al [6,8,9,12,13,[16][17][18][19]21,22,[24][25][26][27][28][29]. When the appendix is inadequate for the conduit because of adhesions or inappropriate structures, when the appendix is surgically absent, or when the appendix is previously used for a continent urinary channel, alternate techniques are required.…”

“…Other reports in which tube sigmoidostomy has been performed have yielded similar results. It has been suggested that tube sigmoidostomy is a simpler technique because of redundancy of the mesentery [17,21].…”

“…Before December 2003, we performed the conduit from the appendix or the wall of the cecum in 23 patients as follows: reversed appendicostomy as described by Malone et al [6] in 1 patient, a simpler orthotopic appendicostomy [11,21] in 6 patients, and a neoappendicostomy using a cecal flap [12] in 16 patients. A neoappendicostomy using a cecal flap was created in which the appendix had previously been removed, the appendix was difficult to mobilize because of severe periappendiceal inflammation, or a urologic conduit formation was needed.…”

“…Recent reports have suggested that a left colon ACE can be performed to overcome the problem of an ACE conduit using an appendiceal or cecal flap [16][17][18][19][20][21][22].…”