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Antegrade Continent Colonic Conduit

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Constipation

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Conclusion

Thus far, CCC surgery has been performed in heterogeneous groups of patients with chronic intractable constipation in whom pathophysiology and etiology often differed. For example, patients with both slow-transit constipation and disordered rectal evacuation, secondary to either a mechanical (large rectocoele) or functional obstruction (pelvic floor dyssynergia) have been included, as have patients with lifelong idiopathic symptoms, as well as patients who have acquired their symptoms following pelvic surgery (hysterectomy; secondary to continence-restoring operations). In addition, we have combined CCC formation with an ESGN procedure, as part of total anorectal reconstruction for patients born with anorectal atresia, who have had a poor functional result (persistent soiling, constipation) following initial surgery. Although early results with the CCC are promising, and equivalent to those of the more established ACE, with successful evacuation, improved continence, and resolution of abdominal symptoms appearing possible in all patient groups studied, the numbers are small and controlled trials (perhaps in comparison to other methods of antegrade irrigation), involving more homogeneous patient groups, may help to identify specific determinants of success for this procedure. Certainly, patient education and multidisciplinary support are integral to obtaining a successful outcome, and patients must be highly motivated and be capable of self-administering the enema.

In our experience, the CCC has particularly revolutionized bowel care in a small highly selected subset of patients with chronic constipation or soiling/constipation secondary to anorectal atresia, who wish to avoid a permanent end-stoma. Notably, failure of this procedure does not preclude further surgical intervention. Despite these very exciting preliminary results, its place as a therapy for idiopathic constipation remains to be determined.

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Authors and Affiliations

  1. Centre for Academic Surgery and Gastrointestinal Physiology Unit, Barts and the London, Queen Mary’s School of Medicine and Dentistry, Royal London Hospital, London, UK

    Marc A. Gladman PhD, MBBS, MRCOG, MRCS, S. Mark Scott PhD & Norman S. Williams MS, FRCS, FMedSci

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  1. Marc A. Gladman PhD, MBBS, MRCOG, MRCS
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  2. S. Mark Scott PhD
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  3. Norman S. Williams MS, FRCS, FMedSci
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Editors and Affiliations

  1. Cleveland Clinic Florida, Weston, FL, USA

    Steven D. Wexner MD, FACS, FRCS, FRCS (Ed) (21st Century Oncology Chair in Colorectal Surgery Chairman, Department of Colorectal Surgery Chief of Staff, Professor of Surgery and Clinical Professor of Surgery) (21st Century Oncology Chair in Colorectal Surgery Chairman, Department of Colorectal Surgery Chief of Staff, Professor of Surgery and Clinical Professor of Surgery)

  2. Ohio State University Health Sciences Center at the Cleveland Clinic Foundation, Columbus, OH, USA

    Steven D. Wexner MD, FACS, FRCS, FRCS (Ed) (21st Century Oncology Chair in Colorectal Surgery Chairman, Department of Colorectal Surgery Chief of Staff, Professor of Surgery and Clinical Professor of Surgery) (21st Century Oncology Chair in Colorectal Surgery Chairman, Department of Colorectal Surgery Chief of Staff, Professor of Surgery and Clinical Professor of Surgery)

  3. University of South Florida College of Medicine, Tampa, FL, USA

    Steven D. Wexner MD, FACS, FRCS, FRCS (Ed) (21st Century Oncology Chair in Colorectal Surgery Chairman, Department of Colorectal Surgery Chief of Staff, Professor of Surgery and Clinical Professor of Surgery) (21st Century Oncology Chair in Colorectal Surgery Chairman, Department of Colorectal Surgery Chief of Staff, Professor of Surgery and Clinical Professor of Surgery)

  4. Charles E. Schmitt College of Science, Florida Atlantic University, Boca Raton, FL, USA

    Steven D. Wexner MD, FACS, FRCS, FRCS (Ed) (21st Century Oncology Chair in Colorectal Surgery Chairman, Department of Colorectal Surgery Chief of Staff, Professor of Surgery and Clinical Professor of Surgery) (21st Century Oncology Chair in Colorectal Surgery Chairman, Department of Colorectal Surgery Chief of Staff, Professor of Surgery and Clinical Professor of Surgery)

  5. University of Hull, Cattingham, UK

    Graeme S. Duthie MD, FRCS, FRCSEd (Reader in Surgery and Honorary Consultant Colorectal Surgeon) (Reader in Surgery and Honorary Consultant Colorectal Surgeon)

  6. Hull and East Yorkshire NHS Trust, Castle Hill Hospital, Cottingham, UK

    Graeme S. Duthie MD, FRCS, FRCSEd (Reader in Surgery and Honorary Consultant Colorectal Surgeon) (Reader in Surgery and Honorary Consultant Colorectal Surgeon)

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Gladman, M.A., Scott, S.M., Williams, N.S. (2006). Antegrade Continent Colonic Conduit. In: Wexner, S.D., Duthie, G.S. (eds) Constipation. Springer, London. https://doi.org/10.1007/978-1-84628-275-1_23

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  • DOI: https://doi.org/10.1007/978-1-84628-275-1_23

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