title: The left Monti-Malone procedure: Preliminary results in seven cases.
abstract: OBJECTIVE
  The management of children who have congenital intestinal dysfunction and continuous feces soiling has been improved significantly by the Malone continent caecostomy. When the appendix is not available, the Monti tube represents a good alternative to create a catheterizable conduit. The authors report here 7 cases of left continent colonic access (left Monti-Malone).
  
  
  METHODS
  From July 1999 to January 2001 7 patients have been operated on in our unit: 6 spina bifida, 1 cloacal exstrophy. Technically, a ring of descending colon of 1.5 to 2 cm width is isolated with its meso, the Monti's tube fashioned, and implanted into the left colon according to the Malone's technique. Antegrade bowel washouts start 3 weeks after surgery with standard saline (200 to 500 mL) +/- phosphate enemas. A period of 1 to 3 months is needed to adjust to the right enema regimen to get a satisfactory result.
  
  
  RESULTS
  The follow-up range is 18 months to 1.5 months. One patient is excluded. The duration of the enemas varies between 10 and 30 minutes, and the number of enemas varies from 1 to every 2 or 3 days. Five children are clean and perform their antegrade enemas after dinner to avoid the embarrassment of post enema leakages.
  
  
  CONCLUSIONS
  Although it is a short series with a short follow-up, the first results collected show a significant shortening of the duration of the enema with excellent outcomes in terms of continence.
authors.affiliation: Lyon, France.
authors.forename: R B
authors.initials: RB
authors.lastname: Liloku
authors.forename: P Y
authors.initials: PY
authors.lastname: Mure
authors.forename: L
authors.initials: L
authors.lastname: Braga
authors.forename: Th
authors.initials: T
authors.lastname: Basset
authors.forename: P D
authors.initials: PD
authors.lastname: Mouriquand
mesh_terms: D000293:Adolescent; D000328:Adult; D001065:Appendix / Q000601:surgery; D002431:Cecostomy / Q000379:methods*; D002648:Child; D003106:Colon / Q000502:physiology / Q000601:surgery*; D003248:Constipation / Q000209:etiology / Q000628:therapy; D003672:Defecation / Q000502:physiology; D013505:Digestive System Surgical Procedures / Q000379:methods; D004733:Enema / Q000379:methods*; D005242:Fecal Incontinence / Q000209:etiology / Q000517:prevention & control / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D010528:Peristalsis / Q000502:physiology; D016135:Spinal Dysraphism / Q000150:complications / Q000601:surgery; D054047:Surgical Stomas; D016896:Treatment Outcome