Tube sigmoidostomy: a modification of the antegrade colonic evacuation

Left-colon antegrade continence enema (LACE) procedure for fecal incontinence

“…[4][5][6] The left colon ACE (LACE) offers several advantages including a convenient stoma location in the left upper quadrant of the abdomen, gravity-assisted evacuation, avoidance of the right and transverse colon, which have a large volume capacity and in which the bulk of water reabsorption occurs, and predictable bowel movements.…”

Is the outcome of the left colon antegrade continence enema better than that of the right colon antegrade continence enema?

“…There have been numerous modified surgical procedures since the first report by Malone et al [6,8,9,12,13,[16][17][18][19]21,22,[24][25][26][27][28][29]. When the appendix is inadequate for the conduit because of adhesions or inappropriate structures, when the appendix is surgically absent, or when the appendix is previously used for a continent urinary channel, alternate techniques are required.…”

“…Other reports in which tube sigmoidostomy has been performed have yielded similar results. It has been suggested that tube sigmoidostomy is a simpler technique because of redundancy of the mesentery [17,21].…”

“…Recent reports have suggested that a left colon ACE can be performed to overcome the problem of an ACE conduit using an appendiceal or cecal flap [16][17][18][19][20][21][22].…”

Left Antegrade Continent Enema (LACE): Review of the Literature

“…Malone antegrade continent enema has changed the quality of life in many children with faecal incontinence [18,20,25]. Although, in adults, the use of gastric tube for access to the descending colon had been described before [3], it was in 2002 that reports about the open surgical techniques of LACE (left-sided antegrade continence enema) in children started appearing [7,15,23]. We first described the new percutaneous endoscopic technique of LACE in children in 2002, and subsequently published a larger series in 2004 [9,19].…”