Transition and reversal: long-term experience of the MACE procedure in children

Peeraully, Riyad; Langley, Jason; Hayes, Nicola; Storry, Kate; Richardson, Louise; Burridge, Demelza; More, Bharat

doi:10.1007/s00383-022-05122-1

Cited by 6 publications

(6 citation statements)

References 19 publications

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“…ACE outcomes in children with ARMs are difficult to discern in the literature as studies are limited by heterogenous design and patient population, variable definitions of success and continence, small sample size and short duration. Approximately 71%–78% of children with ARMs have been reported to be successful with an ACE 62,63 . Chang et al demonstrated that 50/64 (78%) of children with ARM were still using the ACE at 5 years of follow‐up 64 .…”

Section: Medical Management Of a Postsurgical Patient With Anorectal ...mentioning

confidence: 99%

“…Chang et al demonstrated that 50/64 (78%) of children with ARM were still using the ACE at 5 years of follow‐up 64 . Recovery and discontinuation of ACE have been reported in 6%–11% 63–65 . Children with ARMs who had ACE for continence had the lower reversal rate at 9% when compared to children with chronic idiopathic constipation (19%) and Hirschsprung disease (54%) 63 .…”

Section: Medical Management Of a Postsurgical Patient With Anorectal ...mentioning

confidence: 99%

“…Recovery and discontinuation of ACE have been reported in 6%–11% 63–65 . Children with ARMs who had ACE for continence had the lower reversal rate at 9% when compared to children with chronic idiopathic constipation (19%) and Hirschsprung disease (54%) 63 . ACE provides autonomy and independence from the caregiver and has been shown to improve patient and parent quality of life 66 in children and adults 67 .…”

Section: Medical Management Of a Postsurgical Patient With Anorectal ...mentioning

confidence: 99%

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Medical management of anorectal malformations

Ambartsumyan

2024

Aliment Pharmacol Ther

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SummaryBackgroundAnorectal malformations (ARMs) are congenital anomalies of the anorectum and the genitourinary system that result in a broad spectrum of hindgut anomalies. Despite surgical correction patients continue to have late postoperative genitourinary and colorectal dysfunction that have significant impact on quality of life.AimThis paper will review the current evidence and discuss the evaluation and management of postoperative patients with ARMs who present with persistent defecation disorder.MethodsA literature search was conducted using PubMed/MEDLINE/EMBASE databases applying the following terms: ARMs, imperforate anus, constipation, faecal incontinence, neurogenic bowel, posterior sagittal anorectoplasty.ResultsPatients who present with postoperative defecation disorders require timely diagnostic and surgical evaluation for anatomic abnormalities prior to initiation of bowel management. Goals of management are to avoid constipation in young children, achieve faecal continence in early childhood and facilitate independence in older children and adolescents. Treatment options vary from high dose stimulant laxatives to high‐volume retrograde and antegrade enemas that facilitate mechanical colonic emptying.ConclusionsAppropriate diagnostic work‐up and implementation of treatment can decrease long‐term morbidity and improve quality of life in postoperative patients with ARMs who presents with defecation disorders.

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Section: Medical Management Of a Postsurgical Patient With Anorectal ...mentioning

confidence: 99%

Section: Medical Management Of a Postsurgical Patient With Anorectal ...mentioning

confidence: 99%

Section: Medical Management Of a Postsurgical Patient With Anorectal ...mentioning

confidence: 99%

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Medical management of anorectal malformations

Ambartsumyan

2024

Aliment Pharmacol Ther

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“…ACEs were reported to successfully treat fecal incontinence in patients with HD [ 59 ] resulting in social continence in 54–92% of children [ 60 , 61 ] and a four-time decrease in hospital admissions for disimpactions [ 60 ]. Chong et al reported 50% of patients with HD were successfully weaned off the ACE flushes with 40% of children still using ACE and 1/10 participants having failed ACEs at a median 8.5-year follow-up [ 62 ].…”

Section: Management Of Obstructive Episodesmentioning

confidence: 99%

State of the Art Bowel Management for Pediatric Colorectal Problems: Hirschsprung Disease

Bokova,

Prasade,

Janumpally

et al. 2023

Children

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After an initial pull-though, patients with Hirschsprung disease (HD) can present with obstructive symptoms, Hirschsprung-associated enterocolitis (HAEC), failure to thrive, or fecal soiling. This current review focuses on algorithms for evaluation and treatment in children with HD as a part of a manuscript series on updates in bowel management. In constipated patients, anatomic causes of obstruction should be excluded. Once anatomy is confirmed to be normal, laxatives, fiber, osmotic laxatives, or mechanical management can be utilized. Botulinum toxin injections are performed in all patients with HD before age five because of the nonrelaxing sphincters that they learn to overcome with increased age. Children with a patulous anus due to iatrogenic damage of the anal sphincters are offered sphincter reconstruction. Hypermotility is managed with antidiarrheals and small-volume enemas. Family education is crucial for the early detection of HAEC and for performing at-home rectal irrigations.

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“…Antegrade continence enemas (ACEs) allow for administration of the flush from the right colon into the distal colon in an antegrade manner, which is a more physiologic in comparison to the retrograde administration of enemas/irrigations. Peeraully et al reported 78% of children with an ARM achieving "success" on ACEs with or without minor leakage of stool the night after enema administration, and 13% reported improvement of their stooling pattern, with fecal continence not achieved yet [70]. The current updates on ACEs in bowel management are described in a related article "Pediatric Bowel Management Options and Organizational Aspects" [71].…”

Section: Antegrade Continence Enemasmentioning

confidence: 99%

State of the Art Bowel Management for Pediatric Colorectal Problems: Anorectal Malformations

et al. 2023

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Up to 79% of patients with anorectal malformations (ARMs) experience constipation and/or soiling after a primary posterior sagittal anoplasty (PSARP) and are referred to a bowel management program. We aim to report the recent updates in evaluating and managing these patients as part of the manuscript series on the current bowel management protocols for patients with colorectal diseases (ARMs, Hirschsprung disease, functional constipation, and spinal anomalies). The unique anatomic features of ARM patients, such as maldeveloped sphincter complex, impaired anal sensation, and associated spine and sacrum anomalies, indicate their bowel management plan. The evaluation includes an examination under anesthesia and a contrast study to exclude anatomic causes of poor bowel function. The potential for bowel control is discussed with the families based on the ARM index calculated from the quality of the spine and sacrum. The bowel management options include laxatives, rectal enemas, transanal irrigations, and antegrade continence enemas. In ARM patients, stool softeners should be avoided as they can worsen soiling.

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Transition and reversal: long-term experience of the MACE procedure in children

Cited by 6 publications

References 19 publications

Medical management of anorectal malformations

Medical management of anorectal malformations

State of the Art Bowel Management for Pediatric Colorectal Problems: Hirschsprung Disease

State of the Art Bowel Management for Pediatric Colorectal Problems: Anorectal Malformations

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