title: Use of Malone antegrade continence enema in patients with perineal colostomy after rectal resection.
abstract: OBJECTIVE
  Abdominoperineal resection, with iliac colostomy, remains the gold standard treatment for very low-lying rectal cancer, but it alters patients' quality of life. Alternatives to iliac colostomy need to be experimented. Antegrade enemas via a cecal access (Malone operation) obtains a colonic emptying and improves continence for incontinent patients. Continence and quality of life after abdominoperineal resection and perineal colostomy associated to a Malone antegrade continence enema were studied.
  
  
  METHODS
  After abdominoperineal resection for cancer, 18 patients had a digestive reconstruction by perineal colostomy and Malone antegrade continence enema. Patients performed antegrade enemas every 24 to 48 hours with tap water. After six months, continence (Cleveland Clinic score) and quality of life (Fecal Incontinence Quality of Life scale) were recorded.
  
  
  RESULTS
  Morbidity was 5 percent (1 appendix necrosis). All patients could perform antegrade enemas by themselves. Mean continence score was 6.41/20 (standard error, 2.31). Fecal Incontinence Quality of Life scores were: lifestyle 3.18/4 (standard error, 0.83); coping/ behavior 2.99/4 (standard error, 0.83); depression/self-perception 3.11/4 (standard error, 0.83); embarrassment 2.84/4 (standard error, 0.63).
  
  
  CONCLUSIONS
  After abdominoperineal resection, Malone antegrade continence enema associated to perineal colostomy provided an acceptable continence. It preserved patients' body image and resulted in a satisfying quality of life. It could become an alternative to iliac colostomy in selected patients.
authors.affiliation: Department of Digestive Surgery, Faculty of Medicine, University of Paul Sabatier, Toulouse, France. portier.g@chu-toulouse.fr
authors.forename: Guillaume
authors.initials: G
authors.lastname: Portier
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bonhomme
authors.forename: Ivan
authors.initials: I
authors.lastname: Platonoff
authors.forename: Frank
authors.initials: F
authors.lastname: Lazorthes
mesh_terms: D000328:Adult; D000368:Aged; D001828:Body Image; D003125:Colostomy / Q000009:adverse effects*; D004733:Enema; D005242:Fecal Incontinence / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010502:Perineum / Q000601:surgery; D011788:Quality of Life; D019651:Plastic Surgery Procedures; D012004:Rectal Neoplasms / Q000601:surgery*