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Ahmad H, Smith C, Witte A, Lewis K, Reeder RW, Garza J, Zobell S, Hoff K, Durham M, Calkins C, Rollins MD, Ambartsumyan L, Rentea RM, Yacob D, Lorenzo CD, Levitt MA, Wood RJ. Antegrade Continence Enema Alone for the Management of Functional Constipation and Segmental Colonic Dysmotility (ACE-FC): A Pediatric Colorectal and Pelvic Learning Consortium Study. Eur J Pediatr Surg 2024. [PMID: 37940124 DOI: 10.1055/a-2206-6508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
PURPOSE The purpose of the study was to determine if antegrade continence enema (ACE) alone is an effective treatment for patients with severe functional constipation and segmental colonic dysmotility. METHODS A retrospective study of patients with functional constipation and segmental colonic dysmotility who underwent ACE as their initial means of management. Data was collected from six participating sites in the Pediatric Colorectal and Pelvic Learning Consortium. Patients who had a colonic resection at the same time as an ACE or previously were excluded from analysis. Only patients who were 21 years old or younger and had at least 1-year follow-up after ACE were included. All patients had segmental colonic dysmotility documented by colonic manometry. Patient characteristics including preoperative colonic and anorectal manometry were summarized, and associations with colonic resection following ACE were evaluated using Fisher's exact test and Wilcoxon rank-sum test. p-Values of less than 0.05 were considered significant. Statistical analyses and summaries were performed using SAS version 9.4 (SAS Institute Inc., Cary, North Carolina, United States). RESULTS A total of 104 patients from 6 institutions were included in the study with an even gender distribution (males n = 50, 48.1%) and a median age of 9.6 years (interquartile range 7.4, 12.8). At 1-year follow-up, 96 patients (92%) were successfully managed with ACE alone and 8 patients (7%) underwent subsequent colonic resection for persistent symptoms. Behavioral disorder, type of bowel management, and the need for botulinum toxin administered to the anal sphincters was not associated with the need for subsequent colonic resection. On anorectal manometry, lack of pelvic floor dyssynergia was significantly associated with the need for subsequent colonic resection; 3/8, 37.5% without pelvic dyssynergia versus 1/8, 12.5% (p = 0.023) with pelvic dyssynergia underwent subsequent colonic resection. CONCLUSION In patients with severe functional constipation and documented segmental colonic dysmotility, ACE alone is an effective treatment modality at 1-year follow-up. Patients without pelvic floor dyssynergia on anorectal manometry are more likely to receive colonic resection after ACE. The vast majority of such patients can avoid a colonic resection.
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Affiliation(s)
- Hira Ahmad
- Center for Colorectal and Pelvic Reconstruction, Children's Hospital of Orange County, Orange, California, United States
| | - Caitlin Smith
- Department of Pediatric and Thoracic General Surgery, Seattle Children's Hospital, Seattle, Washington, United States
| | - Amanda Witte
- Department of Pediatric Surgery, Children's Hospital of Wisconsin Inc, Milwaukee, Wisconsin, United States
| | - Katelyn Lewis
- Department of Pediatric Surgery, Primary Children's Hospital, Salt Lake City, Utah, United States
| | - Ron William Reeder
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Jose Garza
- Department of Pediatric Surgery, Primary Children's Hospital, Salt Lake City, Utah, United States
| | - Sarah Zobell
- Department of Pediatric Surgery, Primary Children's Hospital, Salt Lake City, Utah, United States
| | - Kathleen Hoff
- Department of Pediatric Surgery, Children's Healthcare of Atlanta Inc, Atlanta, Georgia, United States
| | - Megan Durham
- Division of Pediatric Surgery, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, United States
| | - Casey Calkins
- Department of Pediatric Surgery, Children's Hospital of Wisconsin Inc, Milwaukee, Wisconsin, United States
| | - Michael D Rollins
- Department of Pediatric Surgery, Primary Children's Medical Center, University of Utah, Salt Lake City, Utah, United States
| | - Lusine Ambartsumyan
- Department of Pediatric Surgery, Seattle Children's Hospital and Regional Medical Center, Seattle, Washington, United States
| | - Rebecca Maria Rentea
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Desale Yacob
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, United States
| | - Carlo Di Lorenzo
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, United States
| | - Marc A Levitt
- Department of Surgery, Colorectal and Pelvic Reconstructive Surgery, Children's National Hospital, District of Columbia, Washington, United States
| | - Richard J Wood
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio, United States
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