What happens to children with idiopathic constipation who receive an antegrade continent enema?: An actuarial analysis of 80 consecutive cases

Abstract

Introduction There is uncertainty about the prognosis for children with idiopathic constipation who opt for treatment by colonic lavage using an antegrade continent enema (ACE). The aim of this study was to perform an actuarial analysis of the outcomes of the ACE in children consecutively referred to our unit for this procedure, who suffered from idiopathic constipation and who had failed to respond to 3 years of medically supervised conservative management. Methods This study is a prospective analysis of the outcomes of 80 children with uncontrolled idiopathic constipation who underwent construction of an ACE by 1 surgeon. Results Twelve children were able to stop using their ACE because of resolution of their symptoms. The probability of a child who has idiopathic constipation being able to stop colonic lavage was 0.2, 6.2 years after construction of the ACE. In this group, the estimated mean time to have an ACE reversed was 8.8 years. Twelve children did not achieve satisfactory colonic lavage and either gave up (4) or deteriorated and had alternative treatment for their symptoms (8). The probability of ACE failure is 0.3 at 8.5 years after construction. Girls were significantly more likely to fail than boys, and colonic transit time was significantly longer among children who subsequently required alternative treatment for their symptoms. Conclusions Children with idiopathic constipation whose symptoms fail to resolve with medical management and who are treated with an ACE have 0.2 probability of cure, 0.3 probability of failure, and 0.5 probability of having to continue with colonic lavage after 6 years of colonic lavage.