title: The Malone antegrade continence enema procedure: the Amsterdam experience.
abstract: BACKGROUND
  The Malone antegrade continence enema (MACE) procedure has been previously described as a safe and effective option for the treatment of children with chronic defecation disorders when maximal medical therapy and conventional treatment have failed.
  
  
  OBJECTIVE
  To evaluate clinical success, complications, and quality of life of children with chronic defecation disorders with a MACE stoma.
  
  
  METHODS
  A retrospective analysis of 23 patients who underwent the construction of a MACE stoma was performed. Preoperative and postoperative data were evaluated. A specific questionnaire was used to assess patient satisfaction.
  
  
  RESULTS
  A significant increase was found in defecation frequency (1.0 [range, 0-4] pretreatment vs 5.5 [range, 0-28] posttreatment per week; P < .006) and a significant decrease in fecal incontinence frequency (10 [range, 0-14] pretreatment vs 0 [range, 0-14] posttreatment per week; P < .034). Postoperative complications of the MACE procedure were fecal leakage (43%), wound infection (52%), and stomal stenosis (39%). A total of 86% of the patients were satisfied with the results of the Malone stoma (n = 21).
  
  
  CONCLUSIONS
  The MACE procedure is an effective treatment in children with intractable defecation disorders. Postoperative complications are, however, not uncommon. Further refinement of the technique focused to reduce the complication rate is necessary to expand the application of this approach.
authors.affiliation: Pediatric Surgical Center of Amsterdam, Emma Children's Hospital / AMC, Academic Medical Center, Amsterdam 1105 AZ, The Netherlands. l.t.hoekstra@amc.uva.nl
authors.forename: Lisette T
authors.initials: LT
authors.lastname: Hoekstra
authors.forename: Caroline F
authors.initials: CF
authors.lastname: Kuijper
authors.forename: Roel
authors.initials: R
authors.lastname: Bakx
authors.forename: Hugo A
authors.initials: HA
authors.lastname: Heij
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Aronson
authors.forename: Marc A
authors.initials: MA
authors.lastname: Benninga
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000601:surgery* / Q000628:therapy; D004733:Enema; D005242:Fecal Incontinence / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D011788:Quality of Life; D012189:Retrospective Studies; D054047:Surgical Stomas; D011795:Surveys and Questionnaires; D016896:Treatment Outcome