PURPOSE: Fecal incontinence as a result of anorectal malformation, Hirschsprung's disease, and spina bifida remains a major problem for patients, their families, and for surgeons. The aim of this study was to evaluate the results of an antegrade continence enema (ACE) in children suffering from fecal incontinence. METHODS: An ACE was performed in 18 patients with fecal incontinence due to meningomyelocele between January 1998 and May 2002. Three operative methods were applied: reversed appendicostomy (1/18), orthotopic appendicostomy (5/18) and neoappendicostomy with cecal flap (12/18). The enema solutions used in our patients were the Fleet enema solution, the solin enema solution and the Soft-soap enema solution etc. RESULTS: The overall success rate was 83%. The most common complication was abdominal pain (77.7%) with the other complications being stoma stricture (11.1%), stoma leakage (11.1%), as well as stoma infection, diarrhea, nausea, vomit ing and epigastric soreness. The success of the surgical techniques, the regulation of fecal soiling, and improvement in the quality of life for the patients and their families were evaluated according to the Johns Hopkins Hospital's scoring system. The improvement in the quality of life was 87% with a mean follow-up period of 24 months. CONCLUSION: An ACE procedure appears to be a safe and effective approach for the control of fecal incontinence in pediatric patients with menigomyelocele and significantly improves the quality of life for nearly all patients.