Advertisement

Purpose:

We report the long-term outcome of the Malone antegrade continence enema procedure in the treatment of chronic constipation and fecal incontinence in children with neuropathic bowel.

Materials and Methods:

We performed a retrospective chart review of 256 Malone antegrade continence enema procedures. Patient age at surgery, bowel segment used, location of stoma, number and type of revisions required, and fecal continence were documented and a database was created.

Results:

A total of 236 patients with at least 6 months of followup are included in this report. There were 172 in situ appendicocecostomies, 23 split appendix channels, 9 appendicocecostomies with cecal extension, 22 Yang-Monti ileocecostomies and 10 colon flap channels performed. A total of 112 males (47%) and 124 females (53%) were included in the study. Median patient age at surgery was 9 years (range 2 to 36) and median followup for the entire cohort was 50 months (6 to 115). A total of 56 surgical revisions were performed in 39 patients (17%). Median time to first revision was 9.5 months (range 1 to 105). Stomal stenosis occurred in 32 patients (14%). Overall, surgical revisions were required in 14% of in situ appendix channels (24 of 172), 22% of split appendix channels (5 of 23), 33% of appendix channels with cecal extension (3 of 9), 18% of Yang-Monti Malone antegrade continence enema channels (4 of 22) and 30% of colon flap channels (3 of 10). Independent of channel technique, surgical revisions were required in 15% of umbilical stomas and 18% of lower quadrant stomas (p = 0.516). Two patients had minimal stomal leakage, and 94% (221 of 236) achieved fecal continence with irrigations.

Conclusions:

The long-term results of the Malone antegrade continence enema channel in a large cohort of patients with neuropathic bowel and chronic constipation are encouraging. Of the patients 17% will require revision surgery, and patients/parents should be counseled accordingly. In our series in situ appendicocecostomy had the lowest revision rate on long-term followup, although the difference was not statistically significant (p = 0.226).

References

  • 1 : The Malone antegrade continence enema procedure: quality of life and family perspective. J Urol2003; 169: 320. LinkGoogle Scholar
  • 2 : Preliminary report: the antegrade continence enema. Lancet1990; 336: 1217. Google Scholar
  • 3 : Factors that influence outcomes of the Mitrofanoff and Malone antegrade continence enema reconstructive procedures in children. J Urol2002; 168: 1537. LinkGoogle Scholar
  • 4 : The MACE procedure: experience in the United Kingdom. J Pediatr Surg1999; 34: 338. Google Scholar
  • 5 : The Malone antegrade colonic enema enhances the quality of life in children undergoing urological incontinence procedures. J Urol1996; 155: 1416. LinkGoogle Scholar
  • 6 : The in situ appendix in the Malone antegrade continence enema procedure for faecal incontinence. Br J Urol1997; 79: 985. Google Scholar
  • 7 : The Malone antegrade continence enema. J Pediatr Surg1995; 30: 68. Google Scholar
  • 8 : The Malone antegrade continence enema for neurogenic and structural fecal incontinence and constipation. J Urol1995; 154: 759. LinkGoogle Scholar
  • 9 : Combined Mitrofanoff and antegrade continence enema procedures for urinary and fecal incontinence. J Urol1997; 158: 192. LinkGoogle Scholar
  • 10 : Role of the antegrade continence enema in the management of the most debilitating childhood recto-urogenital anomalies. J Urol1997; 158: 1277. LinkGoogle Scholar
  • 11 : The colon flap/extension Malone antegrade continence enema: an alternative to the Monti-Malone antegrade continence enema. J Urol2005; 174: 299. LinkGoogle Scholar
  • 12 : In situ Malone antegrade continence enema in 127 patients: a 6-year experience. J Urol2004; 172: 1689. LinkGoogle Scholar
  • 13 : Use of a Monti channel for administration of antegrade continence enemas. J Urol2002; 168: 1883. LinkGoogle Scholar
  • 14 : In situ imbricated appendix: experience with a simple MACE technique. J Urol, suppl.1999; 161: 199. abstract 762. Google Scholar
  • 15 : Modified technique of antegrade continence enema using a stapling device. J Urol2000; 163: 589. LinkGoogle Scholar
  • 16 : New techniques for construction of efferent conduits based on the Mitrofanoff principle. Urology1997; 49: 112. Google Scholar
  • 17 : Yang needle tunneling technique in creating antireflux and continent mechanisms. J Urol1993; 150: 830. LinkGoogle Scholar
  • 18 : Colonic tubes for the antegrade continence enema: comparison of surgical technique. J Urol2004; 172: 700. LinkGoogle Scholar
  • 19 : Fecal incontinence in children: treatment with percutaneous cecostomy tube placement—a prospective study. Radiology1997; 203: 621. Google Scholar
  • 20 : Simplified technique for antegrade continence enemas for fecal retention and incontinence. J Am Coll Surg1998; 187: 457. Google Scholar

Division of Pediatric Urology, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana

Advertisement