title: Control of fecal incontinence: continued success with the Malone procedure.
abstract: BACKGROUND
  Our center has previously reported the use of the Malone antegrade continence enema procedure in children. The procedure involves bringing the appendix to the surface of the abdominal wall to provide a nonrefluxing catheterizable channel that enables antegrade colonic lavage for the control of fecal incontinence.
  
  
  METHODS
  This report critically evaluates 23 patients treated for fecal incontinence with up to 6 years of follow-up. After operation, specific scoring criteria were used for assessment. Success in surgical technique, control of fecal soiling, and improvement in quality of life were evaluated.
  
  
  RESULTS
  More than 85% of patients achieved maximal or near-maximal scores in all three categories. Postoperative complications remain a relevant concern when this procedure is undertaken, but we have found that significant postoperative complications are few and can be minimized by meticulous follow-up.
  
  
  CONCLUSIONS
  Overall, the Malone antegrade continence enema procedure has been shown to be safe and highly effective. There is the potential for wider application in older age groups where sphincter and pelvic floor muscles have been compromised as a result of trauma or cancer surgery.
authors.affiliation: Department of Surgery, Johns Hopkins Hospital, School of Medicine, Johns Hopkins University, Baltimore, Md., USA.
authors.forename: S R
authors.initials: SR
authors.lastname: Schell
authors.forename: G J
authors.initials: GJ
authors.lastname: Toogood
authors.forename: N E
authors.initials: NE
authors.lastname: Dudley
mesh_terms: D000293:Adolescent; D002404:Catheterization; D002648:Child; D002675:Child, Preschool; D004733:Enema; D005069:Evaluation Studies as Topic; D005242:Fecal Incontinence / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008488:Medical Illustration; D011183:Postoperative Complications; D011788:Quality of Life; D012086:Reoperation; D012648:Self Care; D016896:Treatment Outcome