Reducing Constipation-Related Admissions: The Effectiveness of Antegrade Continence Enema Procedures in Children

Introduction Constipation in pediatrics remains a common problem. Antegrade continence enema (ACE) procedures have been shown to decrease the distress of daily therapy. Patients are able to administer more aggressive washouts in the outpatient setting. Therefore, we hypothesize that patients following an ACE procedure would have reduced admissions for constipation. Methods Patients who underwent an ACE procedure at a large children’s hospital from 2015 to 2018 were included. Demographics, diagnosis, procedure, and preoperative/postoperative hospital admissions were analyzed. Results Forty-eight patients were included in the study. Over half were diagnosed with idiopathic constipation. Majority of patients underwent an appendicostomy (88%, n = 42). Preoperatively, 26 patients were admitted for a combined total of 63 times for constipation. Postoperatively, 4 patients were admitted for a total of 5 visits ( P = .021). Twenty-eight patients required a nonscheduled appendicostomy tube replacement. Conclusion This study demonstrates ACE procedures can improve constipation-related symptoms in children and are associated with decrease hospital admissions.

Robotic Assisted Ureteric Mitrofanoff Conduit with Malone Antegrade Continence Enema Procedure

Neurogenic bladders requiring self catheterizations have primarily been treated using appendix as the preferred mitrofanoff channel. But in some cases appendix may be absent or maybe required for other procedures as in MACE (Malone Antegrade Continence Enema) for chronic constipation. Here we demonstrate the feasibility of Ureter as the Mitrofanoff channel combined with bladder augmentation and MACE procedure done robotically

Creating awareness of the antegrade continence enema procedure and why nurses need to know about it

The antegrade continence enema (ACE) procedure is mostly associated with children. Many children who underwent this are now entering adulthood and require expert advice and support from nursing and medical services. This article describes how a poster was created to make health professionals aware of this procedure and provide advice for troubleshooting. The type of flushing solution used for irrigation still seems to be selected by trial and error, depending on what suits each individual. There is little evidence in the literature on skin management for patients practising ACE, so it is pertinent to apply the best evidence available. Adult stoma care nurses will need a detailed understanding of this technique and management in the future, as it is likely that they will be called upon for support and advice.