ABSTRACT
The ACE (antegrade continence enema) procedure is now accepted as an established treatment for intractable fecal incontinence secondary to conditions such as spinal dysraphism and anorectal malformation. The successful use of the ACE is described in numerous reports in thousands of patients with follow-up extending to 20 years, and it has also been demonstrated that a successful ACE significantly improves quality of life. Technical modifications have been introduced over the years and these are illustrated in this chapter. It is no longer recommended to disconnect the appendix from the cecum as previously described, and the in situ appendix is now the norm for the open ACE procedure. If no other procedure is required, a laparoscopic antegrade continence enema (LACE) approach is recommended. For patients in whom constipation is a major problem, it may be best to site the conduit in the left colon rather than the cecum.
