Experience of the MACE procedure at a regional pediatric surgical unit: a 15-year retrospective review.
BACKGROUND
The Malone antegrade continence enema (MACE) procedure is an established treatment option for children with constipation or fecal incontinence. This study retrospectively analyses the management and outcomes of children who underwent MACE procedures at a regional pediatric surgery unit.


METHODS
Children who underwent a MACE procedure in our unit between 1998 and 2012 were identified. Demographic and clinical data were obtained from contemporaneous records. Using the continence scale described by Malone, overall outcomes were categorized as full, partial, or failure (full: totally clean or minor rectal leakage on night of washout; partial: clean but significant stoma or rectal leakage, occasional major leak and/or still wearing protection but perceived by child or parent to be an improvement; failure: regular soiling or constipation persisted, no perceived improvement, procedure was abandoned). Data entry and statistical analysis were performed using Excel and SPSS (IBM Corp., Armonk, New York, United States).


RESULTS
A total of 40 children (29 male) were identified for inclusion. Underlying diagnoses were idiopathic constipation (16), anorectal anomalies (14) and Hirschprung's disease (10). The MACE procedure was performed laparoscopically in 26 cases and using an open technique in 14 cases. Mean age at the time of surgery was 8.9 years (range, 3-19 years) and mean follow-up time was 6.5 years (range, 1-10 years). Outcomes categorized as full were 62.5% for chronic idiopathic constipation (CIC), 71.4% for anorectal malformation (ARM), and 70% for Hirschsprung disease (HD). Overall success rates (full and partial outcomes combined) were 87.5% for CIC, 92.8% for ARM, 100% for HD, and 92.5% for all diagnoses taken together. Eleven MACE procedures (27.5%) were reversed, in seven (17.5%) due to the return of spontaneous and regular bowel movements and in four (10%) due to stomal problems.


CONCLUSIONS
This study identified a high success rate (combining full and partial outcomes) of 92.5% for MACE procedures within our unit. An encouraging finding is that the procedure was reversed in a significant proportion of patients following the return of normal bowel habits.
Department of Paediatric Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.
M Riyad
MR
Peeraully
Department of Paediatric Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.
Joana
J
Lopes
Department of Paediatric Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.
Ali
A
Wright
Department of Paediatric Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.
Brian W
BW
Davies
Department of Paediatric Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.
Richard J
RJ
Stewart
Department of Paediatric Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.
Shailinder S
SS
Singh
Department of Paediatric Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.
Bharat B
BB
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D000293:Adolescent; D000071056:Anorectal Malformations; D001006:Anus, Imperforate / Q000150:complications / Q000628:therapy; D001065:Appendix / Q000601:surgery*; D002431:Cecostomy; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000628:therapy*; D004733:Enema / Q000379:methods*; D005242:Fecal Incontinence / Q000628:therapy*; D005260:Female; D006627:Hirschsprung Disease / Q000150:complications / Q000628:therapy; D006776:Hospitals, Pediatric; D006801:Humans; D010535:Laparoscopy; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D013503:Surgery Department, Hospital; D017211:Treatment Failure; D055815:Young Adult