Following the description of the antegrade continence enema (ACE) 7 ye
ars ago, it has become widely performed and accepted as the most succe
ssful treatment for intractable faecal incontinence. Modifications of
the operative technique and enema regimen have been described, but the
basic principle remains. This paper traces the evolution of the ACE a
nd describes criteria for patient selection, operative technique and e
nema regimens.