title: The Malone antegrade colonic enema procedure: outcome and lessons of 6 years' experience.
abstract: The successful management of faecal incontinence can dramatically improve the quality of life of affected children. The introduction of the non-refluxing, catheterisable appendico-caecostomy provides the opportunity to treat previously resistant patients. Over a 6-year period, 29 children had a Malone antegrade continent stoma for enema administration (MACE). Incontinence was related to spina bifida in 12 children, ano-rectal anomaly in 12, Hirschprung's disease in 2, followed excision of a pelvic tumour in 2, and was secondary to intractable chronic constipation in 1. The conduit was fashioned from the appendix (20), a caecal tube (8), or a gastric tube (1). Surgical complications were stomal stenosis (11), wound infection (1), anastomotic leak (1), MACE stoma prolapse (1), and a pressure sore (1). Colonic irrigation was achieved with washouts of saline (24), saline plus phosphate (4), and saline plus Picolax (1). Twenty-three patients have complete control of bowel function, but 4 still soil. Two remain incontinent, 1 of whom is still being instructed. One child subsequently had a colostomy, but still uses the MACE stoma. Successful bowel management requires motivation, dedication, commitment, and the input of a clinical nurse specialist. The MACE is a relatively straightforward operative procedure that provides an effective washout technique that is acceptable to both parents and children.
authors.affiliation: Department of Paediatric Surgery, Manchester Children's Hospitals NHS Trust, Royal Manchester and Booth Hall Children's Hospitals, Manchester, M27 4HA, UK.
authors.forename: C P
authors.initials: CP
authors.lastname: Driver
authors.forename: C
authors.initials: C
authors.lastname: Barrow
authors.forename: J
authors.initials: J
authors.lastname: Fishwick
authors.forename: D C
authors.initials: DC
authors.lastname: Gough
authors.forename: A
authors.initials: A
authors.lastname: Bianchi
authors.forename: A P
authors.initials: AP
authors.lastname: Dickson
mesh_terms: D000293:Adolescent; D002431:Cecostomy; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003106:Colon; D003248:Constipation / Q000209:etiology / Q000628:therapy*; D004733:Enema / Q000379:methods*; D005242:Fecal Incontinence / Q000209:etiology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome