INTRODUCTION AND OBJECTIVES: The ACE has been used frequently for managing the bowel in children with diseases that affect either emptying or fecal continence since it was devised in 1990. We retrospectively evaluated our experience with the ACE to determine its effectiveness and applicability.

METHODS: A chart review of 117 patients who underwent an ACE from 1995 was conducted including 52 males and 65 females, median age 11.2 years (range 2.8 to 35.4 years) with a median follow-up of 27 months (range: 1 - 151, mean: 35). Parameters investigated were: etiology for the bowel dysfunction, source material for the conduit, post-operative complications and need for further surgery, irrigation characteristics, and outcome. Success was defined as > 3 bowel movements and < 1 small accident per week, whereas failure were defined as < 3 BMs and > 1 large accident per week.

RESULTS: Of the 117, bowel dysfunction was due to myelodysplasia (NBD) in 45, intractable colonic dysfunction or functional constipation (ICD) in 30, ano-rectal malformation (ARM) in 25 and other conditions in 17. The ACE was constructed using the appendix in 96, a segment of tubularized ileum in 8 and a percutaneous tube in 13. 114 conduits were right sided into the caecum. Nearly all patients started flushing with 0.9% NaCl, but switched to GoLYTLEY due to a lack of effectiveness. At last encounter, 64% were using GoLYTLEY. The average irrigant volume was 23 ± 16 cc/kg. At last follow-up, 74% of the 45 with NBD, 68% of 30 with ICD and 57% of 25 with an ARM were successful (p >0.5). Outcome did not vary by age or gender. In those deemed successful, 'toilet time' (infusion plus results) was 42.2 minutes whereas in those not considered successful, total 'toilet time' was 59.7 minutes (p <0.001). Time to relapse of bowel symptoms was considerably shorter for ICD (19 mos) versus NBD (60.2 mos) and ARM (39.6 mos). Stomal leakage occurred significantly more often in tubularized ileum than appendiceal conduits (25% versus 14.1%; p = 0.014). Stomal infection was more likely in ICD (29.2%) versus NBD (6.8%) and ARM (4.3%). Surgical complications happened in 55 (47%) including stomal stenosis in 25% (36% of ICD and 32% of NBD), stomal closure due to disuse in 10% (16% of ICD) and surgical revision apart from stomal stenosis in 9.4% (9% in NBD).

CONCLUSIONS: Overall, the ACE procedure effectively controls bowel function by creating regular, predictable bowel movements with minimal leakage in two-thirds but ICD patients have the most difficulty. Toileting time and number of accidents per week play a significant role in who is successful.

Source of Funding: None