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

Abstract

Purpose: LACE is gradually becoming more established for the treatment of constipation. The purpose of this study was to review the current status of LACE procedure in paediatric practice. Materials and Methods: A systematic database search was performed. Patients who underwent a LACE procedure between 2002 and May 2007 were reviewed retrospectively. The data was analysed with respect to indications for operation, operative techniques, outcome, and complications. The outcomes were compared with those of right-sided antegrade colonic enema (RACE) procedures, published in the same period. Results: Nine studies describing 93 patients were identified. The underlying diagnoses were spina bifida (70 %), anorectal malformation (10 %), idiopathic constipation (10 %), Hirschsprung's disease (4 %) and other (6 %). The mean age at operation was 10 years. The various operative procedures used included retubularisation of the sigmoid colon (31 %), retubularisation of the splenic flexure (28 %), left Monti from the descending colon (15 %), and retubularisation of the ileum (3 %). Minimally invasive techniques were used in 23 % of cases. Mean volume of enema used was 414 ml. The mean transit time for enema was 31 minutes. Social continence was achieved in 94 % (complete in 72 %; partial in 22 %) cases. Stomal stenosis was seen in 14 % of cases, of which 9 % required revision of the stoma and 5 % responded to dilatation. Sixteen studies describing 583 patients were found for RACE. Indications for operation were similar to those for LACE. Open procedures were done in 86 % of cases, and laparoscopic assisted procedures in 14 % of cases. Mean age at operation was 10 years. Mean volume of enema used 618 ml. Median evacuation time was 53 minutes. Continence was achieved in 94 % of cases. Stomal stenosis occurred in 26 %. Conclusion: The results of LACE procedures are encouraging, especially in light of the lower amount of enema fluid required, the quicker enema transit time and fewer complications. Overall outcome (continence) is comparable to that of RACE.

Key words

Malone antegrade continence enema - left antegrade continence enema - faecal incontinence

References

• 1 Ahn S M, Han S W, Choi S H. The result of antegrade continence enema using a retubularized sigmoidostomy.  Pediatr Surg Int. 2004;  20 488-491
• 2 Antao B, Ng J, Robert J. Laparoscopic antegrade continence enema using a two-port technique.  J Laparoendosc Adv Surg Tech A. 2006;  16 168-173
• 3 Bruce R G, el-Galley R E, Wells J, Galloway N T. Antegrade continence enema for the treatment of fecal incontinence in adults: use of gastric tube for catheterizable access to the descending colon.  J Urol. 1999;  161 1813-1816
• 4 Calado A A, Macedo Jr A, Barroso Jr U, Netto J M, Liguori R, Hachul M, Garrone G, Ortiz V, Srougi M. The Macedo-Malone antegrade continence enema procedure: early experience.  J Urol. 2005;  173 1340-1344
• 5 Cataldo P A. History of stomas. Mackeigan JM, Kataldo PA ntestinal Stomas: Principles, Techniques and Management. St Louis, MO; Quality Medical Publishing 1993: 3-37
• 6 Churchill B M, Ugarte D A, Atkinson J B. Left colon antegrade continence enema (LACE) procedure for fecal incontinence.  J Pediatr Surg. 2003;  38 1778-1780
• 7 Gauderer M WL, DeCou J M, Boyle J T. Sigmoid irrigation tube for the management of chronic evacuation disorders.  J Pediatr Surg. 2002;  37 348-351
• 8 Gutierrez C, Marco A, Nogales A, Tebar R. Total and segmental colonic transit time and anorectal manometry in children with chronic constipation.  J Pediatr Gastoenterol Nutr. 2002;  35 31-38
• 9 Haddad M, Clarke S, Fell J M. Percutaneous colostomy of the left colon: a new technique for the management of intractable chronic constipation.  Pediatr Endosurg Innov Tech. 2002;  6 207-210
• 10 Hozo S P, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample.  BMC Medical Research Methodology. 2005;  5 13 DOI: 10.1186/1471-2288-5-13
• 11 Kim J, Beasley S W, Maoate K. Appendicectomy stomas and antegrade colonic irrigation after laparoscopic antegrade continence enema.  J Laparoendosc Adv Surg Tech A. 2006;  16 400-403
• 12 Kim S M, Han S W, Choi S H. Left colonic antegrade continence enema: experience gained from 19 cases.  J Pediatr Surg. 2006;  41 1750-1754
• 13 King S K, Sutcliffe J R, Southwell B R, Chait P G, Hutson J M. The antegrade continence enema successfully treats idiopathic slow-transit constipation.  J Pediatr Surg. 2005;  40 1935-1940
• 14 Lemelle J L, Guillemin F, Aubert D, Guys J M, Lottmann H, Lortat-Jacob S, Moscovici J, Mouriquand P, Ruffion A, Schmitt M. A multicentre study of the management of disorders of defecation in patients with spina bifida.  Neugastroenterol Motil. 2006;  18 123-128
• 15 Liloku R B, Mure P Y, Braga L, Basset T, Mouriquand P DE. The left Monti-Malone procedure: preliminary results in seven cases.  J Pediatr Surg. 2002;  37 228-231
• 16 Malone P S, Ransley P G, Keily E M. Preliminary report: the antegrade colonic enema.  Lancet. 1990;  336 1217-1218
• 17 Marshall J, Hutson J M, Anticich N, Stanton M P. Antegrade continence enemas in the treatment of slow transit constipation.  J Pediatr Surg. 2001;  36 1227-1230
• 18 Mattix K D, Novotny N M, Shelley A A, Rescorla F J. Malone antegrade continence enema (MACE) for fecal incontinence in imperforate anus improves quality of life.  Pediatr Surg Int. 2007;  23 1175-1177
• 19 Rawat D J, Haddad M, Geoghegan N, Clarke S, Fell J M. Percutaneous endoscopic colostomy of the left colon: a new technique for management of intractable constipation in children.  Gastrointestinal Endoscopy. 2004;  60 39-43
• 20 Soylet Y, Yesildag E, Besik C, Emir H. Antegrade continent enema – an analysis of 20 children with faecal incontinence.  Eur J Pediatr Surg. 2006;  16 251-254
• 21 van den Berg M M, Hogan M, Caniano D A, Di Lorenzo C, Benninga M A, Mousa H M. Colonic manometry as predictor of cecostomy success in children with defecation disorders.  J Pediatr Surg. 2006;  41 730-736
• 22 Villarreal J, Sood M, Zangen T, Flores A, Michel R, Reddy N, Di Lorenzo C, Hyman P E. Colonic diversion for intractable constipation in children: colonic manometry helps guide clinical decisions.  J Pediatr Gastroenterol Nutr. 2001;  33 588-591
• 23 Whineray Kelly E, Bowkett B. Tube sigmoidostomy: a modification of the antegrade colonic evacuation.  A NZ J Surg. 2002;  72 397-399
• 24 Yagmurlu A, Harmon C M, Georgeson K E. Laparoscopic cecostomy button placement for the management of fecal incontinence in children with Hirschsprung's disease and anorectal anomalies.  Surg Endosc. 2006;  20 624-627
• 25 Yerkes E B, Cain M P, King S, Brei T, Kaefer M, Casale A J, Rink P C. The Malone antegrade continence enema procedure: quality of life and family perspective.  J Urol. 2003;  169 320-323