Ain-Shams experience in the management of end stage fecal incontinence using antegrade continence enema

Abstract

The Malone antegrade continence enema (ACE) has revolutionized the management of intractable fecal incontinence. In this technique, the appendix or neoappendix is brought to the abdominal wall creating a small stoma. Thereby, antegrade enemas can be administered to empty the colorectum and prevent accidents of fecal incontinence. The aim of this study was to assess the results of the ACE in adults suffering from end-stage fecal incontinence. Ten adult male patients with severe incontinence due to different etiologies were included in the study. The appendix was used in eight and Ileal- neoappendix was created in two. The ideal appendicostomy was that anastomosed to V-skin flap with an antireflux procedure. All the patients achieved almost complete cleanliness with those having neurogenic cause for their incontinence being the most satisfied regardless the stoma complication or appearance. The impact on social activities and quality of life caused by bowel dysfunction was reduced in all ten patients. We conclude that the ACE technique can be reasonably used to treat selected adult patients suffering from fecal incontinence after all other measures have failed or are not applicable due to the expense or the complex technological back up needed to maintain their success.