Long-term results for malone antegrade continence enema for adults with neurogenic bowel disease

Teichman, Joel M.H.; Zabihi, Nasim; Kraus, Stephen R.; Harris, Julia M.; Barber, Douglas B.

doi:10.1016/s0090-4295(02)02282-3

Cited by 54 publications

(39 citation statements)

References 13 publications

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“…The mean time required was 40 min and almost all patients (15) performed an enema every 2 or 3 days. Combining this result with the physical global scale of the 36-Item Short-Form Health Survey health status questionnaire, it appears that physical quality of life is almost normal after the Malone operation or equivalent, which is in accordance with several previous studies 7,26,28 .…”

Section: Discussionsupporting

confidence: 90%

Outcome of antegrade continence enema procedures for faecal incontinence in adults

Lefèvre

Parc

Giraudo

et al. 2006

British Journal of Surgery

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Section: Discussionsupporting

confidence: 90%

Outcome of antegrade continence enema procedures for faecal incontinence in adults

Lefèvre

Parc

Giraudo

et al. 2006

British Journal of Surgery

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“…11 One individual reported an antegrade continence enema; these are common in spina bifida children and have been performed successfully in SCI adults. 12 Colostomy for bowel management after SCI has been found to be effective, 13 but was reported by only 2.4% of respondents (excluded from analysis). The low level of surgical intervention merits exploration as it is possible that some potentially helpful operations are currently under used.…”

Section: Pp0001mentioning

confidence: 99%

Management of neurogenic bowel dysfunction in the community after spinal cord injury: a postal survey in the United Kingdom

2008

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Study design: Postal survey. Objectives: To describe bowel management in community-dwelling spinal cord-injured (SCI) individuals and to explore associations between age, injury, dependency, problems, interventions and satisfaction. Setting: Outpatients of a single SCI unit, in the United Kingdom. Methods: Postal questionnaire to all outpatients with SCI for at least 1 year, of any level or density, aged 18 years or more. Results: Response rate was 48.6% (n ¼ 1334). Median age was 52 years, median duration of injury 18 years. The most common intervention was digital evacuation (56%). Up to 30 min was spent on each bowel care episode by 58% of respondents; 31-60 min by 22%; 14% spent over 60 min. Reported problems included constipation (39%), haemorrhoids (36%) and abdominal distension (31%). Reduced satisfaction with bowel function was associated with longer duration of each bowel care episode, faecal incontinence, greater number of interventions used and more problems reported (all Pp0.001); 130 (9.7%) had undergone any type of surgical bowel intervention. Impact of bowel dysfunction on the respondent's life was rated as significantly greater than other aspects of SCI (Pp0.001). Conclusions: Managing SCI bowel function in the community is complex, time consuming and remains conservative. Despite potential for bias from a low response, for this large group of responders, bowel dysfunction impacted most on life compared with other SCI-related impairments. The study findings demand further exploration of bowel management to reduce impact, minimize side effects and increase the choice of management strategies available.

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“…Stomal stenosis requiring revision occurred in 18% (3/17) of our patients, which is comparable to that reported in other series. [5][6][7]17 One patient (6%) in our series developed a delayed smallbowel obstruction, which required surgical exploration. The risk of major complications following the ACE procedure, although low, underscores the role of proper preoperative counseling.…”

Section: Discussionmentioning

confidence: 84%

“…Using an arbitrary scale, patient-reported bowel function, social function and QOL all significantly improved after the ACE procedure (mean follow-up 75 months). 7 Because SCI is a multifactorial disability, we believe that a diseasespecific QOL instrument, which specifically addresses QOL related to fecal incontinence, is the most appropriate means to measure the QOL impact of the ACE procedure as a procedural outcome in SCI patients. The FIQL instrument not only meets this criterion, but it also correlates with comparable scales of the SF-36 global QOL instrument, which is a widely used measure of QOL in the SCI population.…”

Section: Discussionmentioning

confidence: 99%

“…The ACE procedure allows a patient to administer an enema directly into the cecum via an easily accessible abdominal wall stoma, and it is an effective method for controlling refractory fecal incontinence due to a variety of etiologies in both adult and pediatric populations. [5][6][7][8][9] The ACE procedure has been shown to provide significant improvement in patient and caregiver quality of life (QOL) when used in patients with neurogenic bowel dysfunction due to a variety of etiologies; however, no study has assessed the impact of the ACE procedure on QOL in patients with neurogenic bowel dysfunction due to SCI. [10][11][12] We use a validated QOL instrument, which specifically assesses QOL related to fecal incontinence, to objectively measure changes in QOL related to fecal incontinence before and after the ACE procedure in patients with SCI.…”

Section: Introductionmentioning

confidence: 99%

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Antegrade continence enema procedure: impact on quality of life in patients with spinal cord injury

Smith

Decter

2014

Spinal Cord

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PH Smith and RM DecterStudy design: This is a prospective cohort study. Objectives: Patients with spinal cord injury (SCI) often suffer from severe constipation/fecal incontinence. The antegrade continence enema (ACE) procedure is often used to control these distressing symptoms when medical management fails. Improvement in the quality of life (QOL) following the ACE procedure has been demonstrated in patients with fecal incontinence of various etiologies. We assess the impact of the ACE procedure on QOL in patients with fecal incontinence due to SCI. Setting: This study was conducted in the United States. Methods: We measured the impact of fecal incontinence on QOL in patients with SCI undergoing ACE using the validated fecal incontinence quality of life (FIQL) QOL instrument. The FIQL scores QOL in four domains: lifestyle, coping/behavior, depression/selfperception and embarrassment. Surveys were prospectively administered before and after surgery. Preoperative and postoperative survey scores were compared using two-sample T-test. Results: Between 2003 and 2010, the ACE procedure was performed on 17 patients with SCI, including 10 paraplegic and seven quadriplegic patients with an average age of 33 years at the time of surgery. Scores in all four QOL realms assessed by the FIQL instrument improved significantly following the ACE procedure. Stomal stenosis requiring channel revision occurred in three patients and was the most common complication. Conclusions: This is the first study to our knowledge that assesses the impact of the ACE procedure on the QOL in patients with SCI. Using a validated questionnaire, we demonstrated significant improvement in QOL related to fecal incontinence following the ACE procedure in these patients who are severely affected by their bowel dysfunction.

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Long-term results for malone antegrade continence enema for adults with neurogenic bowel disease

Cited by 54 publications

References 13 publications

Outcome of antegrade continence enema procedures for faecal incontinence in adults

Outcome of antegrade continence enema procedures for faecal incontinence in adults

Management of neurogenic bowel dysfunction in the community after spinal cord injury: a postal survey in the United Kingdom

Antegrade continence enema procedure: impact on quality of life in patients with spinal cord injury

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