FUNCTIONAL RESULTS FOLLOWING THE ANTEGRADE CONTINENCE ENEMA PROCEDURE

Background Forty children who underwent the antegrade continence enema (ACE) procedure for faecal soiling were studied to determine factors predictive of outcome. Methods There were four patient groups: (1) amb ulant with spinal dysraphism (n = 13), (2) wheelchair bound with spina l dysraphism (n = 14), (3) ambulant with miscellaneous disorders (n = 11) and (4) wheelchair bound with miscellaneous disorders (n = 2). Eff ectiveness of the procedure was assessed using technical evaluation an d quality-of-life improvement (QOLI) scores (0-5). Objective assessmen t included colonic transit time (CTT) and anorectal manometry. Median follow-up was 21 (range 5-37) months. Results Some 28 of 40 children a chieved continence. The procedure was reversed in four of 40 children. Of the other 36 children with a functioning ACE stoma, all reported i mprovement in quality of life (mean QOLI score 3.5). There were no sig nificant differences in technical evaluation score, QOLI score, CTT, m anometry findings or continence between ambulant groups and the wheelc hair-bound group with miscellaneous disorders. QOLI score, anorectal s queeze pressure and continence were significantly poorer in those who were wheelchair bound with spinal dysraphism. Absent squeeze pressure was associated with poor outcome. Conclusion Wheelchair-bound children with spinal neuropathy have a poorer outcome following the ACE proced ure. Although ACE is an effective method of promoting faecal continenc e, it is essential to determine the aetiology of incontinence and sphi ncter function before operation.