Tapered terminal ileum conduit for antegrade continence enemas

Surfield, Gregory A.; Andrews, David

doi:10.1007/s00383-005-1535-1

Cited by 3 publications

(2 citation statements)

References 7 publications

(6 reference statements)

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“…Other authors preferred to use the left side of abdomen as stoma [12][13][14]. While most (over 75%) of the authors used the appendix to make the stoma, others used retubularised ileum, open caecal button, caecostomy tube and retubularised colon (descending, transverse and sigmoid) [14][15][16][17][18][19]. The recent trend is towards minimally invasive procedures.…”

Section: Discussionmentioning

confidence: 95%

Antegrade continence enema (ACE): current practice

2008

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The purpose of this study was to assess current status of antegrade continence enema (ACE) procedure taking into account the recent improvement in the technique and outcome. Reviewing our record of 48 patients with ACE procedure performed between January 2002 and May 2007, we found that the underlying diagnoses were idiopathic constipation in 56%, anorectal malformation in 31%, spina bifida in 8% and Hirschsprung's disease in 4%. Mean age of operation was 10.7 years. Appendix was used as stoma in 73% of cases. Stomal stenosis requiring revision was seen in 6% of cases and continence was achieved in 92% of cases. A systematic search of database was performed for the same period. Twenty-four studies describing 676 patients were found. The mean age was 10 years and various sites used for ACE were, right side of abdomen in 71%, umbilicus in 15% and left side of abdomen in 14%. The incidence of open and laparoscopic procedures were 87 and 13%, respectively. Appendix was used for stoma in 76% procedures. Other operative modalities were retubularised colon, retubularised ileum, caecal button and caecostomy tube, etc. The mean volume of enema fluid used was 516 ml. The mean evacuation time was 42 min. Stomal stenosis requiring revision was seen in 13% of cases. Continence was achieved in 93% of cases. There has been significant improvement in the outcome during last 5 years in comparison to the outcome published in late 1990s. Advancements in techniques, better-trained stoma care nurses and better stoma appliances could have played major role in this success.

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Section: Discussionmentioning

confidence: 95%

Antegrade continence enema (ACE): current practice

2008

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“…The MACE involves the creation of a neostoma with the appendix anastomosed to the abdominal wall creating a valve mechanism that enables appendix catheterization and avoids stool leakage from the stoma. When the appendix is unusable and/or absent (i.e., due to surgery), a neoappendix may be created with a tubularized cecal flap and/or a tapered terminal ileum conduit [5,6]. Still, the morbidity with these procedures may be significant, including fecal leakage and/ or (neo)appendicular stenosis with subsequent difficulties with the catheter introduction [7].…”

Section: Introductionmentioning

confidence: 99%

The Malone antegrade continence enema adapting a transanal irrigation system in patients with neurogenic bowel dysfunction

Spinelli¹,

Sampogna

Rizzato³

et al. 2021

Spinal Cord Ser Cases

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Introduction Patients with severe neurogenic bowel dysfunction (NBD) may undergo the Malone antegrade continence enema (MACE) surgery to perform antegrade bowel irrigation (ABI). The standard approach may be prevented by a previous appendectomy or complicated by appendicular stenoses and/or stomal leakages. We present the experience by our tertiary referral center for NBD, adopting a modified surgical technique, based on a neoappendix with the terminal ileum to preserve the natural anti-reflux mechanism of the ileocecal valve and avoid stool leakage, and a largely available transanal irrigation (TAI) system to catheterize the neoappendix and perform ABI. Case presentation Three individuals with NBD successfully underwent our modified MACE program. Case 1 had cauda equina syndrome. He underwent surgery at 40. Case 2 was a man who suffered from spinal cord dysfunction due to acute disseminated encephalomyelitis, functionally T12 AIS B, at 57. Case 3 was a man with traumatic L1 AIS B paraplegia. At 60 he underwent surgery after 29 years since the injury. He needed a surgical revision due to a postoperative subcutaneous infection. After 121, 84 and 14 months from surgery, the three individuals performed ABI every 2 days, presented functional stomas, had no fecal incontinence, and reported an NBD score of 6, compared to 40, 33 and 35 pre-operatively. Discussion To our knowledge, this is the first report of MACE combining a tapered terminal ileum conduit and an adapted TAI system. Our approach proved to be a safe and effective strategy for severe NBD avoiding a colostomy.

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