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How long will I have my ACE? The natural history of the antegrade continence enema stoma in idiopathic constipation

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Abstract

Purpose

We aim to determine the natural history of the ACE in idiopathic constipation and factors predictive of closure.

Methods

A retrospective case-note review of all patients undergo ACE formation for idiopathic constipation Jan 2003–Mar 2016. Kaplan–Meier analysis was used to determine ACE survival and Cox’s proportional hazard models to examine potential predictors of closure.

Results

29/84 (35%) ACEs were closed: 21/84 due to success and 8/84 due to failure. Median age of closure was 15.5 years (3.5–23.6). Median ACE survival was 77.0 months (95% CI 58.0–96.0). An ACE survival curve was derived from which we estimate that 5-year post-ACE, one-third of patients can expect to have had their ACE closed. Younger age at ACE was predictive of earlier closure (p = 0.023) and closure for success (p < 0.001). Neither patient sex (p = 0.546) nor presence of psychological comorbidities (p = 0.769) predicted likelihood of closure. Incontinence 6-week post-ACE was also associated with increased likelihood of closure (p = 0.042).

Conclusion

The ACE survival curve estimates the proportion of patients with idiopathic constipation who can expect closure (either due to success or failure) at certain timepoints. This may be useful for patient counseling. Younger age at ACE was associated with earlier closure (for success).

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Acknowledgements

The authors would like to thank Mr. Harry Ward, Mr. Paul Charlesworth, Mr. Simon Phelps, and Continence Nurse Specialists Susan McDowell and Sally Dalton for their contribution to the care and management of these patients.

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Authors and Affiliations

  1. Department of Paediatric Surgery, The Royal London Hospital, Whitechapel Road, London, E1 1BB, UK

    A. Kate Khoo, Evita Askouni, Sonia Basson, Jessica Ng & Stewart Cleeve

Authors
  1. A. Kate Khoo
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  2. Evita Askouni
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  3. Sonia Basson
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  4. Jessica Ng
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  5. Stewart Cleeve
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Correspondence to Stewart Cleeve.

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The authors declare that they have no conflict of interest.

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Khoo, A.K., Askouni, E., Basson, S. et al. How long will I have my ACE? The natural history of the antegrade continence enema stoma in idiopathic constipation. Pediatr Surg Int 33, 1159–1166 (2017). https://doi.org/10.1007/s00383-017-4128-x

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  • DOI: https://doi.org/10.1007/s00383-017-4128-x

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