The Antegrade Continence Enema Procedure Using Retubulized Sigmoidostomy

Ahn, Soo Min; Kang, In Suk; Choi, Seung Hoon

Abstract

PURPOSE
A Malone appendicostomy and a Monti ileostomy are effective surgical modalities for treating children with congenital intestinal dysfunction or fecal incontinence. However, a left colonic antegrade continence enema (ACE) has been reported as an alternative. This paper evaluated the efficiency of ACE, using a retubulized sigmoidostomy (RS), for maintaining fecal continence, and its acceptability as a first line surgical treatment. METHODS: 11 patients underwent surgery between March 2002 and July 2003: 8 meningomyelocele, 1 cloacal anomaly, 1 anorectal malformation and 1 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 begun 12 days after surgery using only normal saline. The outcome were assessed after adjusting the appropriate enema regimen for the 11 cases. RESULTS: The mean duration of the enema was 22.0+/-8.4 minutes, with 250 ml (80~800 ml) as the median volume of fluid used. The enema interval ranged from 1 to 3 days. No patient showed any abdominal discomfort or soiling episodes, with the exception of one that experienced day-time fecal staining, but this occurred less than once per month. The self-cosmesis for the umbilical stoma was satisfactory. CONCLUSION: The RS procedure provided excellent continence control, with a shortening of the duration of the enema, a lower fluid volume and good cosmesis, without any ACE related abdominal pain. This procedure can be used as the first choice surgical treatment for intractable constipation and fecal incontinence.