Treatment of a leaking ACE conduit with Deflux injections

Abstract

Faecal leakage from the catheter conduit can be troublesome and reduces the convenience of use of antegrade continence enema (ACE). We report the results of Deflux injection treatment for leaking ACE conduits in nine patients. From 1994 to the end of 2005, 81 patients underwent a procedure for ACE [appendicostomy with wrap (AW) n = 29, appendicostomy straight (AS) n = 44, Monti-Yang ileal tube (MY) n = 5, lateral caecal flap (LCF) n = 1, caecal tube (CT) n = 1, sigmoid tube (ST) n = 1]. Nine (11%) patients (AW n = 3, AS n = 1, MY n = 3, LCF n = 1, ST n = 1) had persistent stomal leak and underwent Deflux injections of the ACE conduit. With the patients in general anaesthesia, the conduit was visualised with CH10.5 cystoscope. At the junction of the conduit and colon, 0.5-1.0 ml of Deflux was injected submucosally at three sites to create intermingling mounds in order to narrow the conduit. After the injections, a balloon catheter was left in the conduit for 3-7 days. When necessary, the injections were repeated. The result was graded as no improvement, moderate improvement, significant improvement. Nine patients underwent a median of 2 (range 1-4) injections. No major complications occurred. The results after a median follow-up of 22 (range 3-53) months from the first injection were as follows: no improvement (n = 1), moderate improvement (n = 5), significant improvement (n = 3). Repeated injection of the ACE conduit with Deflux is a low invasive method and provides moderate to good results in the majority of the patients who suffer from faecal leakage from conduit.

Antegrade continence enema (ACE): current practice

“…Half of our cases responded to conservative treatment and the rest required Chait tube. The options described in the literature for leaking ACE were caecal imbrication around the appendix, stoppers, placement of tubes (Chait or silastic) and injection of Deflux Ò into the submucosal layer at the junction of conduit and colon [7,9,[25][26][27][28]. Other important complications of ACE procedures are abdominal pain, granulation tissue, stomal infection, stomal prolapse, perforation, peritonitis and adhesion-obstruction.…”

The appendix as a conduit for antegrade continence enemas in patients with anorectal malformations: lessons learned from 163 cases treated over 18 years

“…Nearly 3 decades later, a multitude of technical modifications have been reported with the goal of improving functional outcomes while at the same time reducing the incidence and morbidity of complications [17][18][19][20][21][22][23]. In this regard, functional outcomes and complication rates remain substantial and highly variable across reported experiences.…”

Endoscopic injection of submucosal bulking agents for the management of incontinent catheterizable channels

“…Technical variation in the creation of the continent channels and the difference in the continence mechanism between CUCs and ACEs may limit one technique from being applied to all incontinent channels. Some authors report injection at the area of the continence mechanism and at various sites along the channel [7,9,10]. We report our technique that concentrates the bulking agent into the area of the failed continence mechanism.…”

“…Koivusalo et al utilized injections of dextranomer/hyaluronic acid in nine patients with fecal incontinence per their ACE [10]. The site of the injection was the appendicocecal valve in eight patients, and the skin site and appendicocecal valve in one patient.…”