Malone antegrade continence enema

Surgical procedure for bowel management

The Malone antegrade continence enema (MACE) is a surgical procedure designed to help individuals with severe fecal incontinence or constipation manage their bowel movements. This procedure is particularly beneficial for patients with spina bifida, anorectal malformations, or other conditions that affect bowel control.

History

The MACE procedure was first described by Dr. Paul Malone in 1990. It was developed as an alternative to traditional methods of bowel management, providing a more controlled and socially acceptable way for patients to achieve continence.

Procedure

The MACE procedure involves creating a conduit for enema administration. This is typically done using the appendix, which is brought to the surface of the abdomen to form a stoma. If the appendix is unavailable, a segment of the ileum or colon may be used instead.

Diagram of the human digestive system

Surgical Technique

The surgery begins with the identification and mobilization of the appendix. The distal end of the appendix is then brought to the abdominal wall, usually at the level of the umbilicus, and a stoma is created. This stoma allows for the antegrade administration of enemas, which helps to evacuate the colon.

Postoperative Care

After the procedure, patients are taught how to administer enemas through the stoma. This typically involves the use of a catheter to introduce a saline solution into the colon, promoting bowel evacuation. Regular follow-up is necessary to ensure the stoma remains functional and to address any complications.

Indications

The MACE procedure is indicated for patients who have difficulty achieving bowel continence through conventional means. It is particularly useful for:

• Patients with neurogenic bowel due to spinal cord injury or spina bifida.
• Individuals with severe chronic constipation unresponsive to medical therapy.
• Patients with anorectal malformations who require a more effective method of bowel management.

Complications

While the MACE procedure is generally safe, it is not without potential complications. These may include:

• Stomal stenosis or narrowing, which can impede catheterization.
• Leakage around the stoma.
• Infection or irritation of the stoma site.
• Appendiceal or conduit dysfunction.

Outcomes

The MACE procedure has been shown to significantly improve quality of life for patients with severe bowel management issues. Most patients achieve a high degree of continence and report satisfaction with the procedure.

Images of Malone appendicostomy

Related pages

• Fecal incontinence
• Spina bifida
• Anorectal malformation
• Neurogenic bowel dysfunction