title: Left-colon antegrade enema (LACE): Long-term experience with the Macedo-Malone approach.
abstract: We evaluated the long-term results with a left antegrade continence enema (LACE) approach: "Macedo-Malone (MM) procedure" to define parameters such as clinical durability of the technique and patients' compliance with the method.
  
  
  
  We reviewed the medical records of all patients that underwent the MM procedure in our institution since 2001 and conducted a telephonic interview to investigate the use of the enema and satisfaction with the procedure.
  
  
  
  Thirty-five MM procedures were performed, but eight patients lost to follow-up were excluded. Fifteen patients (55%) were female. Myelomeningocele was the clinical diagnoses in 25 (93%). Mean age at surgery was 9 years (3-27 years) and mean follow-up was 75 months (median: 56 months). The indication for LACE was clinically intractable constipation with fecal leakage. Most patients still used the stoma regularly to do the enema (74%). Mean washout time was 27 min (2-90 min). The revision rate due to stenosis was 22.2% (6/27) and all underwent suprafascial revision. We performed one classical MACE by infrafascial approach as a salvage procedure. Overall reoperation rate was 25.8% and fecal continence was 89%. There were no reports of leakage through the stoma. Among patients who still used the stoma, 74% were satisfied with surgery and would strongly recommend the procedure to another patient.
  
  
  
  The MM procedure is a straightforward procedure, which can be performed in 15-20 min, avoids additional entero-entero anastomosis, precludes the use of the appendix, and has shown comparable results to either "classical" MACE or other LACE variants. Neurourol. Urodynam. 36:111-115, 2017. © 2015 Wiley Periodicals, Inc.
authors.affiliation: Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Christophe B
authors.initials: CB
authors.lastname: Anselmo
authors.affiliation: Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Rafael D R
authors.initials: RD
authors.lastname: do Amaral
authors.affiliation: Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Diego E G
authors.initials: DE
authors.lastname: Oliveira
authors.affiliation: Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Marcela Leal
authors.initials: ML
authors.lastname: da Cruz
authors.affiliation: Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Riberto
authors.initials: R
authors.lastname: Liguori
authors.affiliation: Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Gilmar
authors.initials: G
authors.lastname: Garrone
authors.affiliation: Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Bruno
authors.initials: B
authors.lastname: Leslie
authors.affiliation: Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Sérgio L
authors.initials: SL
authors.lastname: Ottoni
authors.affiliation: Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Valdemar
authors.initials: V
authors.lastname: Ortiz
authors.affiliation: Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Antonio
authors.initials: A
authors.lastname: Macedo
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003106:Colon; D004733:Enema / Q000009:adverse effects / Q000379:methods*; D005242:Fecal Incontinence / Q000209:etiology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008591:Meningomyelocele / Q000150:complications / Q000601:surgery; D010349:Patient Compliance; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: fecal incontinence and constipation; left antegrade continent enema; neurogenic bladder