The Macedo-Malone Antegrade Continence Enema Procedure: Early Experience

Abstract

The Macedo-Malone procedure is a relatively straightforward operative approach providing an effective washout technique that is acceptable to parents and children.

Tapered terminal ileum conduit for antegrade continence enemas

“…The Malone stoma is of smaller caliber and stomal stenosis is decreased with daily intubation of the stoma [3]. Tubularized colonic flaps and appendiceal conduits have a significant stenosis rate often requiring dilation or surgical revision [4][5][6]. While the Malone stoma is still the best documented option for antegrade continence enemas, the terminal ileum should be kept in the surgeon's armamentarium for patients without an adequate appendix.…”

Is the outcome of the left colon antegrade continence enema better than that of the right colon antegrade continence enema?

“…There have been numerous modified surgical procedures since the first report by Malone et al [6,8,9,12,13,[16][17][18][19]21,22,[24][25][26][27][28][29]. When the appendix is inadequate for the conduit because of adhesions or inappropriate structures, when the appendix is surgically absent, or when the appendix is previously used for a continent urinary channel, alternate techniques are required.…”

“…An 8F to 10F silicone Foley catheter was placed for 2 weeks in the appendix on the mucosal surface or on the flap to allow tubularization. An antireflux method for the continent valve mechanism was made by simple intussusception of the appendix or a new conduit into the cecum or descending colon [18,23]. In forming the stoma, a simple suture between the distal end of the conduit and the skin was placed in all cases.…”

“…Recent reports have suggested that a left colon ACE can be performed to overcome the problem of an ACE conduit using an appendiceal or cecal flap [16][17][18][19][20][21][22].…”

The Malone Antegrade Continence Enema (MACE) principle in children: is it important if the conduit is implanted in the left or the right colon?

“…Calado et al (5) believed that the left colon was the more physiologically appropriate location, with a decrease in the risk of water absorption as well as a decrease in the time required for enema administration and washout, thereby increasing patient satisfaction and compliance. The enema performed in right colon often is long and tedious for handicapped patients, as the volume of washout from the cecum to the rectum is large, especially in neuropathic bowels prone to dolichosigmoid (5).…”