{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T22:46:33Z","timestamp":1792622793019,"version":"4.5.0"},"reference-count":20,"publisher":"Georg Thieme Verlag KG","issue":"02","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr Surg"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>We aimed to describe long-term outcome, treatment success, and complications of antegrade continence enema (ACE) procedures considering underlying etiologies and associated disorders.<\/jats:p>\n                  <jats:p>Overall, 180 patients undergoing ACE procedure at our institution during 1997\u20132019 were included in this retrospective study. Treatment success was defined as patient staying clean.<\/jats:p>\n                  <jats:p>The main underlying etiologies included spina bifida (n\u2009=\u200965, 36%), anorectal malformations (n\u2009=\u200958, 32%), Hirschsprung disease (n\u2009=\u200925, 14%), and functional constipation (n\u2009=\u20097, 4%). The most common complications were stomal leakage (n\u2009=\u200939, 22%), stenosis (n\u2009=\u200938, 21%), infection (n\u2009=\u200935, 19%), and granuloma\/mucosal prolapse of the stoma (n\u2009=\u200934, 19%), and 29% (n\u2009=\u200952) of the patients reported functional problems. Overall, 48% of the patients (n\u2009=\u200987) experienced at least one ACE-related complication. At the latest follow-up, 61% of the patients were using ACE (n\u2009=\u2009110), of whom 86% stayed clean (n\u2009=\u200995). Overall, ACE treatment was successful in 81% of patients (n\u2009=\u2009144), defined as being clean with ACE in current use or after discontinuing ACE treatment as unnecessary. In total, 31% of the patients had stopped using ACE as unnecessary (n\u2009=\u200945). Spina bifida patients were least likely to discontinue ACE usage (n\u2009=\u20099, 14%), followed by anorectal malformation patients (n\u2009=\u200917, 29%), while 32% of Hirschsprung patients (n\u2009=\u20098) and 71% of constipation patients (n\u2009=\u20095) discontinued ACE as unnecessary.<\/jats:p>\n                  <jats:p>As previous studies have also shown, we demonstrated that ACE treatment can be successfully utilized in majority of children with impaired fecal control. Two-thirds of patients continued ACE treatment over 5 years of whom 86% patients were staying clean.<\/jats:p>","DOI":"10.1055\/a-2646-1919","type":"journal-article","created":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T19:57:46Z","timestamp":1751399866000},"page":"095-101","source":"Crossref","is-referenced-by-count":3,"title":["Success of Antegrade Continence Enema (ACE) in Pediatric Patients with Impaired Fecal Control"],"prefix":"10.1055","volume":"36","author":[{"given":"Minna","family":"Tervahartiala","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, New Children's Hospital, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antti","family":"Koivusalo","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, New Children's Hospital, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikko","family":"Pakarinen","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, New Children's Hospital, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,7,15]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.1016\/0140-6736(90)92834-5","article-title":"Preliminary report: the antegrade continence enema","volume":"336","author":"P S Malone","year":"1990","journal-title":"Lancet"},{"issue":"07","key":"ref2","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.17219\/acem\/63032","article-title":"Continent catheterizable conduits in pediatric urology: one-center experience","volume":"26","author":"P Kroll","year":"2017","journal-title":"Adv Clin Exp Med"},{"issue":"08","key":"ref3","doi-asserted-by":"crossref","first-page":"1294","DOI":"10.1016\/S0022-3468(98)90172-5","article-title":"The antegrade continence enema procedure: a review of the literature","volume":"33","author":"J L Graf","year":"1998","journal-title":"J Pediatr Surg"},{"issue":"09","key":"ref4","doi-asserted-by":"crossref","first-page":"1405","DOI":"10.1016\/j.jpedsurg.2014.02.090","article-title":"Follow up of children undergoing antegrade continent enema: experience of over two hundred cases","volume":"49","author":"J Randall","year":"2014","journal-title":"J Pediatr Surg"},{"issue":"06","key":"ref5","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1007\/s00383-008-2130-z","article-title":"Antegrade continence enema (ACE): current practice","volume":"24","author":"C K Sinha","year":"2008","journal-title":"Pediatr Surg Int"},{"issue":"05","key":"ref6","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1097\/MPG.0b013e3181ff6042","article-title":"Long-term follow-up of patients after antegrade continence enema procedure","volume":"52","author":"A A Siddiqui","year":"2011","journal-title":"J Pediatr Gastroenterol Nutr"},{"issue":"02","key":"ref7","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1111\/nmo.12018","article-title":"Factors associated with successful decrease and discontinuation of antegrade continence enemas (ACE) in children with defecation disorders: a study evaluating the effect of ACE on colon motility","volume":"25","author":"L Rodriguez","year":"2013","journal-title":"Neurogastroenterol Motil"},{"issue":"01","key":"ref8","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1053\/jpsu.2003.50012","article-title":"After the honeymoon\u2014medium-term outcome of antegrade continence enema procedure","volume":"38","author":"R Dey","year":"2003","journal-title":"J Pediatr Surg"},{"issue":"02","key":"ref9","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1016\/j.jpedsurg.2005.11.007","article-title":"Are cecal wrap and fixation necessary for antegrade colonic enema appendicostomy?","volume":"41","author":"A Koivusalo","year":"2006","journal-title":"J Pediatr Surg"},{"issue":"02","key":"ref10","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1016\/j.jpedsurg.2008.10.097","article-title":"What happens to children with idiopathic constipation who receive an antegrade continent enema? An actuarial analysis of 80 consecutive cases","volume":"44","author":"B Jaffray","year":"2009","journal-title":"J Pediatr Surg"},{"issue":"01","key":"ref11","doi-asserted-by":"crossref","first-page":"161958","DOI":"10.1016\/j.jpedsurg.2024.161958","article-title":"What happens post-Malone? An investigation of long-term postoperative management of antegrade continence enemas","volume":"60","author":"E M Encisco","year":"2025","journal-title":"J Pediatr Surg"},{"issue":"11","key":"ref12","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.1007\/s00383-014-3602-y","article-title":"Antegrade continence enema (ACE): predictors of outcome in 111 patients","volume":"30","author":"S Basson","year":"2014","journal-title":"Pediatr Surg Int"},{"issue":"01","key":"ref13","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1055\/s-0033-1357502","article-title":"Experience of the MACE procedure at a regional pediatric surgical unit: a 15-year retrospective review","volume":"24","author":"M R Peeraully","year":"2014","journal-title":"Eur J Pediatr Surg"},{"issue":"06","key":"ref14","doi-asserted-by":"crossref","first-page":"1274","DOI":"10.1016\/j.jpedsurg.2009.02.030","article-title":"After the honeymoon comes divorce: long-term use of the antegrade continence enema procedure","volume":"44","author":"I E Yardley","year":"2009","journal-title":"J Pediatr Surg"},{"issue":"03","key":"ref16","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.1016\/j.juro.2008.05.062","article-title":"The Malone antegrade continence enema: single institutional review","volume":"180","author":"A H Bani-Hani","year":"2008","journal-title":"J Urol"},{"issue":"12","key":"ref17","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1007\/s00383-007-2026-3","article-title":"Malone antegrade continence enema (MACE) for fecal incontinence in imperforate anus improves quality of life","volume":"23","author":"K D Mattix","year":"2007","journal-title":"Pediatr Surg Int"},{"issue":"12","key":"ref18","doi-asserted-by":"crossref","first-page":"1935","DOI":"10.1016\/j.jpedsurg.2005.08.011","article-title":"The antegrade continence enema successfully treats idiopathic slow-transit constipation","volume":"40","author":"S K King","year":"2005","journal-title":"J Pediatr Surg"},{"issue":"02","key":"ref19","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1016\/S0022-3468(99)90204-X","article-title":"The MACE procedure: experience in the United Kingdom","volume":"34","author":"J I Curry","year":"1999","journal-title":"J Pediatr Surg"},{"issue":"04","key":"ref20","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1007\/s00383-018-4416-0","article-title":"Long-term outcomes of antegrade continence enema in children with chronic encopresis and incontinence: what is the optimal flush to use?","volume":"35","author":"S S Ayub","year":"2019","journal-title":"Pediatr Surg Int"},{"issue":"11","key":"ref21","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.1007\/s00383-017-4128-x","article-title":"How long will I have my ACE? The natural history of the antegrade continence enema stoma in idiopathic constipation","volume":"33","author":"A K Khoo","year":"2017","journal-title":"Pediatr Surg Int"}],"container-title":["European Journal of Pediatric Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2646-1919.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T23:37:18Z","timestamp":1772840238000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2646-1919"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,1]]},"references-count":20,"journal-issue":{"issue":"02","published-online":{"date-parts":[[2026,3,6]]},"published-print":{"date-parts":[[2026,4]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2646-1919","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0939-7248","1439-359X"],"issn-type":[{"value":"0939-7248","type":"print"},{"value":"1439-359X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,7,1]]},"published":{"date-parts":[[2025,7,1]]}}}