Appendicostomy Antegrade Colonic Irrigation by Electromechanical Pump: A Novel Method for Managing Fecal Incontinence, Randomized Clinical Trial
Abstract
Antegrade colonic irrigation enema (ACIE) is established as an old treatment for child fecal incontinence and recently is approved as a treatment for different causes of adult fecal incontinence (cancer surgery, neurogenic bowel, spinal cord injury, sphincter trauma, etc.). Despite the benefits of emptying the large bowel and prevention of fecal incontinence or constipation, this method is time-consuming and requires thorough instruction and training. The purpose of this study was to innovate and assess novel technique to decrease time-consuming and improve performance of irrigation. We designed and electromechanical pump for colon irrigation and assessed by a randomized crossover clinical trial study, involving two-four weeks treatment phases. 30 patients have included that suffered fecal incontinence and had been managed with appendicostomy antegrade colon irrigation. The results showed that the pump decrease time and volume of irrigation compare with the traditional method. All patients had a reduction in toileting times. Traditional mean toileting time was 67 minutes, versus pump-toileting time that was 24.6 minutes (P:0.00). The volume of water was reduced in 13 patients. Mean of the volume was 1712 ml in the traditional method and 1128 ml in pump method (P:0.279). Mean Cleveland Clinic Florida Fecal Incontinence score (CCF_FIS) for the pump was 5.84 compare 6.24 for traditional method (P:0.000). Our study provides evidence for the first time that our novel method can facilitate and speed-up colon irrigation without any adverse effect on the outcome.
Leigh RJ, Turnberg LA. Faecal incontinence: the unvoiced symptom. The Lancet. 1982;319(8285):1349-51.
Nelson R, Norton N, Cautley E, Furner S. Community-based prevalence of anal incontinence. JAMA: the journal of the American Medical Association. 1995;274(7):559-61.
Macmillan AK, Merrie AEH, Marshall RJ, Parry BR. The prevalence of fecal incontinence in community-dwelling adults: a systematic review of the literature. Diseases of the colon & rectum. 2004;47(8):1341-9.
Jorge JMN, Wexner SD. Etiology and management of fecal incontinence. Diseases of the colon & rectum. 1993;36(1):77-97.
Kamm MA. Fortnightly review: Faecal incontinence. Bmj. 1998;316(7130):528.
Nelson RL. Epidemiology of fecal incontinence. Gastroenterology. 2004;126:S3-S7.
Glickman S, Kamm M. Bowel dysfunction in spinal-cord-injury patients. The Lancet. 1996;347(9016):1651-3.
Malone PS, Wheeler RA, Williams JE. Continence in patients with spina bifida: long term results. Archives of disease in childhood. 1994;70(2):107-10.
Johanson J, Lafferty J. Epidemiology of fecal incontinence: the silent affliction. The American journal of gastroenterology. 1996;91(1):33.
Lahr C. Evaluation and treatment of incontinence. Practical Gastroenterol. 1988;12:27-35.
Lundby L, Duelund-Jakobsen J. Management of fecal incontinence after treatment for rectal cancer. Current opinion in supportive and palliative care. 2011;5(1):60.
Christensen P, Olsen N, Krogh K, Laurberg S. Scintigraphic assessment of colostomy irrigation. Colorectal Disease. 2002;4(5):326-31.
Dini D, Venturini M, Forno G, Bertelli G, Grandi G. Irrigation for colostomized cancer patients: a rational approach. International journal of colorectal disease. 1991;6(1):9-11.
Griffiths D, Malone P. The Malone antegrade continence enema. Journal of pediatric surgery. 1995;30(1):68-71.
Hughes S, Williams N. Continent colonic conduit for the treatment of faecal incontinence associated with disordered evacuation. British journal of surgery. 1995;82(10):1318-20.
O'bichere A, Sibbons P, Dore C, Green C, Phillips R. Experimental study of faecal continence and colostomy irrigation. British journal of surgery. 2002;87(7):902-8.
Gosselink M, Darby M, Zimmerman D, Smits A, Van Kessel I, Hop W, et al. Long‐term follow‐up of retrograde colonic irrigation for defaecation disturbances. Colorectal Disease. 2004;7(1):65-9.
Sinha CK, Grewal A, Ward HC. Antegrade continence enema (ACE): current practice. Pediatric surgery international. 2008;24(6):685-8.
Malone P, Ransley P, Kiely E. Preliminary report: the antegrade continence enema. The Lancet. 1990;336(8725):1217-8.
Curry J, Osborne A, Malone P. The MACE procedure: experience in the United Kingdom. Journal of pediatric surgery. 1999;34(2):338-40.
Levitt M, Soffer S, Pena A. Continent appendicostomy in the bowel management of fecally incontinent children. Journal of pediatric surgery. 1997;32(11):1630-3.
Koivusalo A, Pakarinen M, Rintala RJ. Are cecal wrap and fixation necessary for antegrade colonic enema appendicostomy? Journal of pediatric surgery. 2006;41(2):323-6.
Casale P, Grady RW, Feng WC, Joyner BD, Mitchell ME. A novel approach to the laparoscopic antegrade continence enema procedure: intracorporeal and extracorporeal techniques. The Journal of urology. 2004;171(2):817-9.
Antao B, Ng J, Roberts J. Laparoscopic antegrade continence enema using a two-port technique. Journal of Laparoendoscopic & Advanced Surgical Techniques. 2006;16(2):168-73.
Rongen MJGM, Gerritsen A, Baeten CGMI. Cecal access for antegrade colon enemas in medically refractory slow-transit constipation. Diseases of the colon & rectum. 2001;44(11):1644-9.
Emmertsen KJ, Laurberg S. Bowel dysfunction after treatment for rectal cancer. Acta Oncologica. 2008;47(6):994-1003.
Yang CC, Stiens SA. Antegrade continence enema for the treatment of neurogenic constipation and fecal incontinence after spinal cord injury. Archives of physical medicine and rehabilitation. 2000;81(5):683-5.
TEICHMAN JMH, Harris J, CURRIE DM, BARBER DB. Malone antegrade continence enema for adults with neurogenic bowel disease. The Journal of urology. 1998;160(4):1278-81.
Churchill BM, De Ugarte DA, Atkinson JB. Left-colon antegrade continence enema (LACE) procedure for fecal incontinence. Journal of pediatric surgery. 2003;38(12):1778-80.
Krogh K, Laurberg S. Malone antegrade continence enema for faecal incontinence and constipation in adults. British journal of surgery. 1998;85(7):974-7.
Christensen P, Olsen N, Krogh K, Laurberg S. Scintigraphic assessment of antegrade colonic irrigation through an appendicostomy or a neoappendicostomy. British journal of surgery. 2002;89(10):1275-80.
Christensen P, Buntzen S, Krogh K, Laurberg S. Ileal neoappendicostomy for antegrade colonic irrigation. British journal of surgery. 2001;88(12):1637-8.
Koch SMP, Rietveld M, Govaert B, Van Gemert W, Baeten CGMI. Retrograde colonic irrigation for faecal incontinence after low anterior resection. International journal of colorectal disease. 2009;24(9):1019-22.
Lasser P, Dube P, Guillot J, Elias D. Pseudocontinent perineal colostomy following abdominoperineal resection: technique and findings in 49 patients. European Journal of Surgical Oncology (EJSO). 2001;27(1):49-53.
Farroni N, Van den Bosch A, Haustermans K, Van Cutsem E, Moons P, D’hoore A, et al. Perineal colostomy with appendicostomy as an alternative for an abdominal colostomy: symptoms, functional status, quality of life, and perceived health. Diseases of the colon & rectum. 2007;50(6):817-24.
Abbes Orabi N, Vanwymersch T, Paterson H, Mauel E, Jamart J, Crispin B, et al. Total perineal reconstruction after abdominoperineal excision for rectal cancer: long‐term results of dynamic graciloplasty with Malone appendicostomy. Colorectal Disease. 2011;13(4):406-13.
Portier G, Bonhomme N, Platonoff I, Lazorthes F. Use of Malone antegrade continence enema in patients with perineal colostomy after rectal resection. Diseases of the colon & rectum. 2005;48(3):499-503.
Koch SM, Uludağ Ö, El Naggar K, Van Gemert WG, Baeten CG. Colonic irrigation for defecation disorders after dynamic graciloplasty. International journal of colorectal disease. 2008;23(2):195-200.
Graf JL, Strear C, Bratton B, Housley HT, Jennings RW, Harrison MR, et al. The antegrade continence enema procedure: a review of the literature. Journal of pediatric surgery. 1998;33(8):1294-6.
Yerkes EB, Cain MP, King S, Brei T, Kaefer M, Casale AJ, et al. The Malone antegrade continence enema procedure: quality of life and family perspective. The Journal of urology. 2003;169(1):320-3.
Chang KJ, Erickson RA, Schandler S, Coye T, Moody C. Per-rectal pulsed irrigation versus per-oral colonic lavage for colonoscopy preparation: a randomized, controlled trial. Gastrointestinal endoscopy. 1991;37(4):444-8.
Fritscher-Ravens A, Mosse CA, Mills T, Ikeda K, Swain P. Colon cleaning during colonoscopy: a new mechanical cleaning device tested in a porcine model. Gastrointestinal endoscopy. 2006;63(1):141-3.
Obstein K. Advanced endoscopic technologies for colorectal cancer screening. 2012.
Teichman JMH, Zabihi N, Kraus SR, Harris JM, Barber DB. Long-term results for Malone antegrade continence enema for adults with neurogenic bowel disease. Urology. 2003;61(3):502-6.
Ellsworth P, Webb H, Crump J, Barraza M, Stevens P, Mesrobian HGJ. The Malone antegrade colonic enema enhances the quality of life in children undergoing urological incontinence procedures. The Journal of urology. 1996;155(4):1416-8.
Hill J, Stott S, MacLennan I. Antegrade enemas for the treatment of severe idiopathic constipation. British journal of surgery. 1994;81(10):1490-1.
Koyle MA, Kaji DM, Duque M, Wild J, Galansky SH. The Malone antegrade continence enema for neurogenic and structural fecal incontinence and constipation. The Journal of urology. 1995;154(2):759-61.
Webb HW, Barraza MA, Crump JM. Laparoscopic appendicostomy for management of fecal incontinence. Journal of pediatric surgery. 1997;32(3):457-8.
Meier DE, Foster ME, Guzzetta PC, Coln D. Antegrade continent enema management of chronic fecal incontinence in children. Journal of pediatric surgery. 1998;33(7):1149-52.
Gerharz EW, Vik V, Webb G, Leaver R, Shah PJR, Woodhouse CRJ. The value of the MACE (Malone antegrade colonic enema) procedure in adult patients. Journal of the American College of Surgeons. 1997;185(6):544-7.
Perez M, Lemelle J, Barthelme H, Marquand D, Schmitt M. Bowel management with antegrade colonic enema using a Malone or a Monti conduit: Clinical results. European journal of pediatric surgery. 2001;11(5):315-8.
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Issue | Vol 57, No 4 (2019) | |
Section | Original Article(s) | |
DOI | https://doi.org/10.18502/acta.v57i4.1840 | |
Keywords | ||
Appendicostomy Antegrade colon irrigation (ACIE) Fecal incontinence |
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