title: Modified cecal flap neoappendix for the Malone antegrade continence enema procedure: a novel technique.
abstract: OBJECTIVE
  We report our experience with the creation of a tubularized cecal flap to construct a neoappendix. This flap effectively serves as an alternative means of creating a conduit for antegrade continence enemas in patients who have either an absent or an unusable appendix.
  
  
  METHODS
  We reviewed our results from our initial 4 patients in whom we used this technique. A neoappendix is created from a medially based flap of distal cecum that is tubularized over a catheter and then buried in a seromuscular tunnel to create an antireflux mechanism. A skin stoma is then created.
  
  
  RESULTS
  All stomas are continent, functional and without any evidence of stenosis or necrosis of the cecal flap with followup ranging from 3 months to 8 years.
  
  
  CONCLUSIONS
  A medially based cecal flap neoappendix is an easily created and reliable conduit for antegrade enemas. This procedure should be considered within the surgical armamentarium of urologists and pediatric surgeons when the appendix is absent, atretic or fibrotic.
authors.affiliation: Division of Pediatric Urology, Schneider Children's Hospital/Long Island Jewish Medical Center, New Hyde Park, New York, USA.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Weiser
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Stock
authors.forename: Moneer K
authors.initials: MK
authors.lastname: Hanna
mesh_terms: D001065:Appendix / Q000601:surgery*; D002432:Cecum / Q000601:surgery*; D002648:Child; D004733:Enema; D004766:Enterostomy / Q000379:methods*; D005242:Fecal Incontinence / Q000209:etiology / Q000601:surgery*; D006801:Humans; D016135:Spinal Dysraphism / Q000150:complications; D013524:Surgical Flaps; D007507:Therapeutic Irrigation