Abstract
Aim of the Study Stomal stenosis is the commonest complication of the antegrade colonic enema (ACE)
procedure, reportedly occurring in 25–55% of patients. As such, a simple ACE stopper
device (a small silicone plug sited in the ACE conduit between catheterisations) was
designed to prevent stenosis. We performed a long-term follow-up study to determine
the effectiveness of the stopper device.
Methods A retrospective case note review was performed of all patients who successfully underwent
a primary ACE procedure over an 8.5-year period (January 2002 to June 2010). The inclusion
criteria were (i) a minimum of 6 months follow-up, (ii) simple appendicostomy, (iii)
caecal/colonic flap. In all patients an ACE stopper was sited in the conduit for at
least 4 months and removed only for catheterisation. Data are mean±SEM.
Main Results 38 children were included in our study. Mean age at surgery was 9.6±0.5 years. Surgery
was performed in 22 patients for incontinence and in 16 for chronic constipation.
31 underwent an appendicostomy and 7 had a caecal/colonic flap; all received an ACE
stopper. The mean follow-up was 2.6±0.3 years. Only 3 patients (8%) developed stomal
stenosis. The first occurred 6 months postoperatively, resulting from an ACE stopper
which was too small and consequently persistently fell out. This conduit required
dilatation. The second occurred at 27 months secondary to a stomal infection and required
surgical revision. The third occurred 8 months postoperatively for no obvious cause,
and was treated with dilation. 1 patient experienced stomal leakage.
Conclusion The ACE stopper is a simple yet highly effective method of preventing stomal stenosis.
We recommend using the stopper in all ACE patients.
Keywords
antegrade continence enema - stoma - stenosis
