In Situ Malone Antegrade Continence Enema in 127 Patients: A 6-Year Experience

Herndon, C.D. Anthony; Rink, Richard C.; Cain, Mark P.; Lerner, Michelle A.; Kaefer, Martin; Yerkes, Elizabeth B.; Casale, Anthony J.

doi:10.1097/01.ju.0000138528.55602.20

Cited by 56 publications

(16 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Nowadays, the appendix is left in situ; its tip is excised and brought out as an appendicostomy. The caecum may be imbribed [10] around the base of the appendix or a caecal wrap may be used to create a valve [4]. Whether the presence of a continence valve improves stomal continence is debatable.…”

Section: Discussionmentioning

confidence: 98%

Antegrade continence enema in the treatment of obstructed defaecation with or without faecal incontinence

et al. 2005

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 98%

Antegrade continence enema in the treatment of obstructed defaecation with or without faecal incontinence

et al. 2005

View full text Add to dashboard Cite

show abstract

“…Hoekstra et al 6 reported relatively similar results of SS on almost the same scale from 1 to 10 in children with intractable defecation disorders. In their study, 86% of the patients were satisfied, with a median score of 8 (range, [6][7][8][9][10]. In this study, we analyzed the factors influencing patient satisfaction.…”

Section: Discussionmentioning

confidence: 95%

“…With almost the same techniques, Herndon et al reported that stomal revisions were required in 11 (8.7%) patients, which was lower than other previous reports. 7,9 They suggested that the reason for their low stomal revision rate was preservation of cecal blood supply at the base of the appendix, thereby limiting its dependence on an isolated appendiceal mesentery.…”

Section: Discussionmentioning

confidence: 99%

Satisfaction after the Malone antegrade continence enema procedure in patients with spina bifida

et al. 2013

View full text Add to dashboard Cite

Study design: Retrospective chart review. Objective: To evaluate the clinical outcomes and factors influencing patient satisfaction with Malone antegrade continence enema (MACE) in patients with spina bifida. Setting: Japan. Methods: We performed retrospective analysis of 21 patients with spina bifida who underwent surgical creation of an MACE stoma. Clinical outcomes were evaluated by medical records, operative notes and mailed questionnaires. Patient satisfaction scores (SSs) were measured on a modified visual analog scale (VAS) from 1 to 10, and the factors influencing the SS were analyzed. Results: A 100% return rate for the mailed questionnaires was achieved. All patients underwent in situ appendicocecostomy with cecal plication. There was only one complication that required surgical revision. Regarding fecal continence, the overall success rate was 90%. Although 4 patients (19%) had severe irrigation pain and 4 patients (19%) found the washout time intolerably long, 18 (85%) of them were satisfied with the MACE procedure. Age at operation, experience of retrograde colonic enema (RCE), experience of stomal leakage, increased comfort at school or workplace and increased comfort at sleepovers significantly influenced SSs. Conclusion: MACE is a valuable option in achieving fecal continence in patients with spina bifida, with most patients being satisfied with the procedure. In our analysis, younger age at operation, previous experience of RCE, no stomal leakage and improvement of quality of life (enhanced comfort at school, workplace and sleepovers) significantly influenced the high satisfaction after MACE. Spinal Cord (2014) 52, 54-57; doi:10.1038/sc.2013.111; published online 1 October 2013Keywords: Malone antegrade continence enema; quality of life; patient satisfaction; fecal incontinence; spina bifida INTRODUCTIONThe Malone antegrade continence enema (MACE) procedure, which was first described in 1990 by Malone et al., 1 has revolutionized the management and improved the quality of life (QOL) of patients with spina bifida who suffer from refractory constipation and fecal incontinence. However, it has been reported in a long-term followup study that a considerable number of patients have ceased the MACE procedure. 2 To select good candidates for the MACE procedure among patients with spina bifida, it is important to evaluate not only the status of the bowel, but also the overall patient satisfaction after the procedure. The aim of this study was to evaluate the factors that influence overall satisfaction after the MACE procedure in patients with spina bifida.

show abstract

“…Malone [4] in 1999 made a survey of members of the British Association of Paediatric Surgeon and found a stomal stenosis rate of 30% in about 300 cases. Herndon [5] in 2004 reviewed 168 cases of continent catheterisable channels and found 13 revisions on 11 patients, two of whom were due to prolapse whilst ten had stenosis and one was for leakage. The time of onset of stenosis has also been studied: Harris CF [6] in a 15 year review reported a 10% stomal stenosis with a 16% revision rate at a median of 7.3 months after the initial procedure.…”

Section: Discussionmentioning

confidence: 98%

Rectus sheath tunnels for continent stomas

2008

View full text Add to dashboard Cite

Continent stoma rectus sheath tunnel (CSRST) has been used in antegrade colonic enema (ACE) and urinary continent cutaneous diversion (UCCD) stomas to reduce leakage and to support a straight track for the continent conduit. All patients that underwent CSRST between 1995 and 2005 were identified and their case notes retrospectively reviewed. Patients were divided into two groups: the ACE group and the UCCD group. Demographic data, age at surgery and complications including stenosis and leakage were recorded. Forty patients underwent CSRST between 1995 and 2005. The mean age and standard deviation (SD) at surgery was 6.8 (2.1) years. Eighteen patients underwent ACE with a mean (SD) follow-up of 7.6 (3.1) years. No patient has faecal leakage. No patient had stomal revision, but one patient (5.5%) required an indwelling gastrostomy button to maintain patency. Twenty-two patients underwent UCCD with a mean (SD) follow-up of 8.1 (2.8) years. No patient developed urinary leakage. Two patients (9%) required revision of the stoma and one (4.5%) required an indwelling catheter because of recurring stomal stenosis. CSRST prevents stoma leakage. Revision surgery rate after CSRST is low, particularly after ACE reconstruction.

show abstract

In Situ Malone Antegrade Continence Enema in 127 Patients: A 6-Year Experience

Abstract: The in situ MACE procedure has reliable long-term results for treating fecal incontinence associated with neuropathic bowel.

Cited by 56 publications

References 19 publications

Antegrade continence enema in the treatment of obstructed defaecation with or without faecal incontinence

Antegrade continence enema in the treatment of obstructed defaecation with or without faecal incontinence

Satisfaction after the Malone antegrade continence enema procedure in patients with spina bifida

Rectus sheath tunnels for continent stomas

Contact Info

Product

Resources

About