Use of customized MIC-KEY gastrostomy button for management of MACE stomal complications.
OBJECTIVE
Severe bowel dysfunction often accompanies neurogenic bladder, and Malone antegrade continence enema procedures can lead to improvement in the quality of life for these patients. The most commonly reported complication has been stomal stenosis of the conduit. We report our experience with the use of the MIC-KEY gastrostomy button for the management of this complication.


METHODS
A retrospective cohort study of 53 consecutive children who had undergone the Malone antegrade continence enema (ACE) procedure from 2000 to 2006 was performed. The records of patients with stomal complications were assessed for presentation, management, and outcomes.


RESULTS
We identified 20 patients (38%) with stomal stenosis. Stomal dilation and stenting alone was successful in 4 patients, and stomal revision was necessary in 16 (30%). Six children required placement of the MIC-KEY gastrostomy button into the ACE stoma for recurrent stomal stenosis (n = 5) or a buried stoma (n = 1). All patients were successfully treated with placement of a MIC-KEY button to continue their bowel irrigation. The size of the button was determined by the endoscopic assessment of the length and width of the ACE stoma and was custom made by the manufacturer. The average time that the button was in place was 26 months, and it was generally changed every 3 months.


CONCLUSIONS
In the rare subset of patients with recurrent stomal stenosis or a buried stoma, the MIC-KEY gastrostomy button was found to be a practical and easy method for the management of these conditions and to preserve the ACE conduit.
Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA. s_heshmat@yahoo.com
Samy
S
Heshmat
William
W
DeFoor
Eugene
E
Minevich
Pramod
P
Reddy
Deborah
D
Reeves
Curtis
C
Sheldon
D000293:Adolescent; D002648:Child; D015331:Cohort Studies; D003248:Constipation / Q000209:etiology / Q000628:therapy*; D003251:Constriction, Pathologic / Q000209:etiology / Q000628:therapy; D004733:Enema / Q000009:adverse effects* / Q000295:instrumentation; D004867:Equipment Design; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D054047:Surgical Stomas / Q000009:adverse effects*; D016896:Treatment Outcome