בשל "הגנת זכויות יוצרים" מובא להלן תקציר המאמר. לקריאתו בטקסט מלא, אנא פנה/י לספרייה הרפואית הזמינה לך
Jonker CAL, Zande JMJ van der, Benninga MA, et al. Antegrade Continence Enemas for Pediatric Functional Constipation: a Systematic Review. Journal of Pediatric Surgery. 2024;0(0). doi:10.1016/j.jpedsurg.2024.161952
Highlights
• Antegrade continence enemas (ACE) are a treatment for functional constipation (FC)
• Treatment success and complication rates of ACE for children with FC vary widely
• There is a need for uniform definitions and guidelines for ACE in children with FC
Abstract
Background
Despite optimal conservative and medical treatment, some children with functional constipation (FC) continue to experience symptoms. Antegrade continence enema (ACE) surgery has been suggested as the primary surgical option after less invasive pharmacological and non-pharmacological interventions have not been effective. The purpose of this systematic review was to assess the outcomes of ACE for children with FC.
Methods
Electronic databases were searched (inception-March 2024) for studies evaluating ACE surgery performed in children with FC. The primary outcome was treatment success (as defined in the original manuscript), including at least defecation frequency and/or fecal incontinence frequency. Secondary outcomes were cessation of ACE, complications, health-related quality of life (HRQoL) and patient/parent satisfaction. Quality of evidence was evaluated based on tools from the New-Ottawa Scale and Joanna Bridge Institute.
Results
Thirteen studies were included, representing 477 children with FC treated with either an appendicostomy or a cecostomy. Reported treatment success rates varied widely, ranging from 32%-100%. ACE treatment was stopped in 15% due to treatment success and in 8% due to treatment failure, leading to more invasive surgery. Complication rates ranged from 6-100%, requiring surgical intervention in 0-34%. An improvement in HRQoL following ACE treatment was reported in all four studies that assessed HRQoL. All three studies assessing patient/parent satisfaction, reported high satisfaction rates.
Conclusion
Reported treatment success and complication rates following ACE surgery for children with FC vary widely. This systematic review highlights the necessity for uniform definitions and treatment guidelines for ACE surgery in children with FC.