Antegrade Continence Enema Approaches

Outcomes, Lessons Learned and Overall Burden in a Mixed Urban–Rural Population

Bibliographic Data

ID15716166
AuthorsB Todd Campbell (University of Missouri), Brooklyn Ondrea Campbell (0009-0007-8230-5711, University of Missouri School of Medicine, Columbia, MO 65212, USA), Andrew Behrmann (0000-0001-5489-4335, University of Missouri), Mahmoud Kutmah (0009-0008-6557-5338, University of Missouri–Kansas City), Canon Dew (University of Missouri), Tara Kempker (0009-0006-3860-6819, University of Missouri), Jessica Peuterbaugh (University of Missouri), Venkataraman Ramachandran (0000-0001-8386-7918, University of Missouri), Yousef El‐Gohary (0000-0002-8655-0948, Division of Pediatric Surgery, University of Missouri School of Medicine, Columbia, MO 65212, USA), Yousef El-Gohary (University of Missouri), Ahmed I Marwan (0000-0002-2194-791X, University of Missouri, corresponding author)
Year2026
Volume13
Issue3
Pages329-329
Publication date2026-02-26
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueChildren (JOURNAL)
Journal identifiersISSN: 2227-9067 • E-ISSN: 2227-9067
PublisherMultidisciplinary Digital Publishing Institute (PUBLISHER • CH)
DOI10.3390/children13030329
PMID41897041
OpenAlexW7131681347
LanguageEN
References cited29

Background : Antegrade continence enemas (ACEs) are administered by appendicostomy or cecostomy to manage bowel conditions. Cecostomies utilize buttons while appendicostomies utilize the appendix for colonic flushing. This study evaluates the outcomes and overall burden of these procedures in a mixed urban-rural population, highlighting unique social determinants of health (SDoH) and access factors. Methods : A retrospective cohort analysis of 31 pediatric patients was conducted at a tertiary academic hospital where 8 underwent a Malone-type ACE (MACE) and 23 underwent a laparoscopic cecostomy (LC) between 2014 and 2024. Results : Age at surgery was significantly higher in the MACE group versus the LC group (14.6 vs. 8.1 years). Patients who underwent MACE had longer hospital stays than patients who underwent LC (7.5 vs. 4.5 days, p = 0.014) and significantly higher 30-day readmissions (5 vs. 2, p = 0.001). Granulation tissue was significant in LC (82.6%) compared to MACE (13.5%, p = 0.001). Moreover, need for surgical revision occurred more in the MACE group (25%). Analysis of SDoH revealed that most of the cohort lived in areas with low childhood opportunity and high socioeconomic deprivation, particularly those undergoing MACE. Financially, MACE was associated with substantially higher total, direct, and indirect costs than LC, with the difference in total cost reaching statistical significance. Conclusions : In this setting,10-year complication rates were low. This reflects the development of a new dedicated longitudinal bowel management program in mid-Missouri. Functional outcomes at the end of the 10-year period were comparable between both cohorts with the achievement of continence. These findings support tailoring surgical approaches to patient needs

Bowel management · Cohort · Cohort study · Complication · Constipation · Mace · Population · Retrospective cohort study · Appendicitis Diagnosis and Management · Congenital gastrointestinal and neural anomalies · Gastrointestinal motility and disorders