Document Detail


Antegrade continence enema for the treatment of fecal incontinence in adults: use of gastric tube for catheterizable access to the descending colon.
MedLine Citation:
PMID:  10332442     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: We describe the use of a gastric segment in performing the antegrade continence enema procedure in patients with refractory fecal incontinence. MATERIALS AND METHODS: The antegrade continence enema procedure was performed in 4 women and 3 men with refractory neurogenic fecal incontinence. Preoperative evaluation included defecography and anorectal manometry. Operative technique involves tunneling a 10 cm. segment of tubularized stomach isolated along the greater curve with preservation of the right gastroepiploic vessels through the anterior tenia of the colon just distal to the splenic flexure. After the stoma is mature the patient passes a catheter and runs 1 to 2 l. warm tap water through it while seated on the toilet. Digital stimulation may be required to initiate bowel emptying and irrigation is continued until clear. RESULTS: Creation of a nonrefluxing catheterizable gastric tube to the descending colon was successful in all 7 patients. At a mean postoperative followup of 22.4 months all patients are continent and use antegrade continence enema irrigation every other day on average. One patient required early revision because of stomal stenosis. Special measures include application of a generic antacid tablet to the stoma and use of a skin barrier. CONCLUSIONS: Catheterizable access to the descending colon for the antegrade continence enema procedure more closely approximates normal defecation patterns by emptying ("unloading") the left side of the colon. The stomach is a suitable option in close proximity for this purpose and is especially advantageous when the appendix is not available. The antegrade continence enema procedure using a gastric segment can be safely and effectively performed, and is well suited for use by reconstructive surgeons who are familiar with the Mitrofanoff principle.
Authors:
R G Bruce; R E el-Galley; J Wells; N T Galloway
Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  The Journal of urology     Volume:  161     ISSN:  0022-5347     ISO Abbreviation:  J. Urol.     Publication Date:  1999 Jun 
Date Detail:
Created Date:  1999-06-23     Completed Date:  1999-06-23     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0376374     Medline TA:  J Urol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1813-6     Citation Subset:  AIM; IM    
Affiliation:
Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Colon / surgery*
Digestive System Surgical Procedures / methods
Enema / methods*
Fecal Incontinence / therapy*
Female
Humans
Male
Middle Aged
Stomach / transplantation*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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