Subscribe to RSS
DOI: 10.1055/s-0030-1265156
© Georg Thieme Verlag KG Stuttgart · New York
Success of Malone's Antegrade Continence Enema (MACE) from the Patients’ Perspective
Publication History
received August 02, 2010
accepted after revision August 16, 2010
Publication Date:
15 October 2010 (online)
![](https://www.thieme-connect.de/media/ejps/201006/lookinside/thumbnails/10.1055-s-0030-1265156-1.jpg)
Abstract
Purpose: Fecal incontinence (FI) is a devastating problem for children. The failure of optimal medical treatment may require further interventions such as appendicocutaneostomy. We report on a patients’ perspective of the success of a Malone procedure for FI.
Patients and Methods: The records of 32 patients who had undergone ACE procedure in the past 9 years were reviewed. Patients and families were contacted, and telephone inquiries were conducted to assess the overall success of the operation. The questionnaire covered the concerns of patients/families about the stoma, functional results and changes in the patients’ quality of life (QOL).
Results: The indications for ACE stomas were meningomyelocele in 17 patients, anorectal malformation in 8, Hirschsprung/NID in 3, spinal tumor in 3 and traumatic spinal injury in one. 7 laparoscopic and 25 conventional operations were performed. The vermiform appendix was used in 27 of the patients and a cecal flap was used in 5. The most frequent complication was stenosis of the stoma orifice observed in 14 patients. 8 patients responded to dilatations while 6 patients required minor surgical revision. There were 2 perforations during catheterization, and they required surgical repair of the conduit. 5 patients had mild leakage from the stoma; all 5 were open ACE procedures, and required revision. 25 patients could be reached by phone. 5 of these children stopped using the stoma due to previous perforation in 2 patients and stricture in 1. The remaining 2 stopped using their stomas because “they did not like the idea of it”. 16 patients are completely clean. 3 patients have occasional soiling. Only one patient was not satisfied with using the ACE stoma and stated that it did not sufficiently improve her condition. 8 patients complained about the duration of the enema (longer than 1 h); however, 5 of them refuse to use the stoma every day. All patients but one perceived a significant improvement in their QOL. Mean QOL scores before and after the procedure were 5.8 (2–9) and 11.5 (5–14), respectively.
Conclusions: ACE stomas provide a satisfactory improvement in patients’ quality of life. Stoma-related complications are not uncommon. The most common problems are strictures, followed by stoma leakage.
Key words
Malone - quality of life - patients’ perspective
References
- 1 Velde S, Biervliet SV, Renterghem KV. et al . Achieving fecal continence in patients with spina bifida: a descriptive cohort study. J Urol. 2007; 178 2640-2644
- 2 Peña A. Anorectal malformations. Semin Pediatr Surg. 1995; 4 35-47
- 3 Peña A, Elicevik M, Levitt MA. Reoperations in Hirschsprung disease. J Pediatr Surg. 2007; 42 1008-1014
- 4 Derikx J, Backer AD, Schoot L. et al . Long-term functional sequelae of sacrococcygeal teratoma: a national study in the Netherlands. J Pediatr Surg. 2007; 42 1122-1126
- 5 Gabra H, Jesudason E, McDowell H. et al . Sacrococcygeal teratoma – a 25 year experience in a UK regional center. J Pediatr Surg. 2006; 41 1513-1516
- 6 Wilmshurst JM, Kelly R, Malgorzata B. Presentation and outcome of sacral agenesis: 20 years’ experience. Dev Med Child Neurol. 1999; 41 806-812
- 7 Morera C, Nurko S. Rectal manometry in patients with isolated sacral agenesis. J Pediatr Gatr Nutr. 2003; 37 47-52
- 8 Bai Y, Yuan Z, Wang W. et al . Quality of life for children with fecal incontinence after surgically corrected anorectal malformation. J Pediatric Surgery. 2000; 35 462-464
- 9 Rintala R, Mildh L, Lindahl H. Fecal incontinence and quality of life in adult patients with an operated high or intermediate anorectal malformation. J Pediatr Surg. 1994; 29 777-780
- 10 Curry JI, Osborne A, Malone PSJ. The MACE procedure: Experience in the United Kingdom. J Pediatric Surgery. 1999; 34 338-340
- 11 Schell S, Toogood G, Dudley N. Control of fecal incontinence: Continued success with the Malone procedure. Surgery. 1997; 122 626-631
- 12 Graf JL, Strear C, Bratton B. et al . The antegrade continence enema procedure: A review of the literature. J Pediatr Surg. 1998; 33 1294-1296
Correspondence
Assoc. Prof. Orkan Ergun
Ege University
School of Medicine
Pediatric Surgery
35100 Izmir
Turkey
Phone: +90 232 390 2814
Fax: +90 232 390 2802
Email: orkan.ergun@ege.edu.tr