title: The role of a colon resection in combination with a Malone appendicostomy as part of a bowel management program for the treatment of fecal incontinence.
abstract: OBJECTIVE
  Surgical options previously described by us as part of a bowel management program for the treatment of soiling and fecal incontinence include (1) resection of a megarectosigmoid to reduce a patient's laxative requirement or (2) a Malone appendicostomy in patients who require enemas. We have found that some patients may benefit from both procedures.
  
  
  METHODS
  We reviewed 18 fecally incontinent patients with structural or functional disorders of the anorectosigmoid (16 ARM, 1 spina bifida, and 1 SCT) who underwent both procedures.
  
  
  RESULTS
  Of 18 patients, the enema regimen prior to resection had an average volume of 681 ml of saline (Range 400-1000 ml) and 60 ml (Range 48-117 ml) of additives (glycerine, castile soap and/or phosphate). Following the colon resection, the average volume of saline and additives was 335 ml (Range 130-650 ml) and 25 ml (Range 0-60 ml), respectively, a 50% reduction for both (P<0.01). The time for enema administration and evacuation was reduced by 25%, and the enemas were more effective, rendering the patients clean in 18 of 18 cases (follow-up was 3 months to 21 years). 2 patients later demonstrated that they could be managed with laxatives alone.
  
  
  CONCLUSIONS
  In patients with poor continence potential and a megarectosigmoid, combining a colon resection with a Malone appendicostomy can make the enema more effective. In some rare cases we found the resection may allow for a better response to laxatives.
authors.affiliation: Division of Pediatric Surgery, Colorectal Center for Children, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
authors.forename: Balgopal
authors.initials: B
authors.lastname: Eradi
authors.forename: Miller
authors.initials: M
authors.lastname: Hamrick
authors.forename: Andrea
authors.initials: A
authors.lastname: Bischoff
authors.forename: Jason S
authors.initials: JS
authors.lastname: Frischer
authors.forename: Michael
authors.initials: M
authors.lastname: Helmrath
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hall
authors.forename: Alberto
authors.initials: A
authors.lastname: Peña
authors.forename: Marc A
authors.initials: MA
authors.lastname: Levitt
mesh_terms: D000293:Adolescent; D001003:Anal Canal / Q000002:abnormalities; D000071056:Anorectal Malformations; D001006:Anus, Imperforate / Q000150:complications; D001065:Appendix / Q000601:surgery*; D002431:Cecostomy / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003082:Colectomy / Q000379:methods*; D003106:Colon / Q000601:surgery*; D003131:Combined Modality Therapy; D003248:Constipation / Q000188:drug therapy; D004733:Enema / Q000379:methods*; D005242:Fecal Incontinence / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D054368:Laxatives / Q000627:therapeutic use; D008297:Male; D008531:Megacolon / Q000601:surgery; D012007:Rectum / Q000002:abnormalities; D012189:Retrospective Studies; D012447:Sacrum / Q000002:abnormalities; D016896:Treatment Outcome
chemical_list: D054368:Laxatives
keywords: Bowel management; Colon resection; Constipation; Enema; Fecal incontinence; Laxative