Abstract
Introduction 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.
Patients and 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.
Conclusion 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.
Keywords
Malone antegrade continence enema - children - fecal incontinence - constipation -
long-term outcome
