Outcomes following Malone antegrade continence enema and their surgical revisions.

Abstract

BACKGROUND/PURPOSE:

The Malone antegrade continence enema (MACE) channel is an effective means to manage patients with neurogenic bowel; however, complications may occur that may require surgical revision. Specific reports of the outcomes of these interventions are limited. We describe our clinical results following revision of MACE.

METHODS:

We retrospectively identified patients undergoing MACE revision for at our institution between 1997 and 2009. Type of MACE (in situ appendicocecostomy (AC = 247), ileocecostomy (IC = 25), cecal flap (CF = 10)) performed was recorded, time from creation to revision, site of revision, and need for repeat surgical revision were recorded.

RESULTS:

Of a total of 282 patients that underwent creation of MACE during the study period, 49 patients (17%) required surgical revision. Of these 49 patients, 42 had undergone AC, four had IC and three had CF. Mean time from MACE creation to revision was 19 months. Sixty-eight revision procedures were performed in the 49 patients. Skin level or endoscopic procedures accounted for 52/67 (78%) procedures. Sixteen patients (33%) required more than one revision and three patients (6%) required more than two procedures.

CONCLUSIONS:

Skin level revisions accounted for over three-fourths of MACE revisions. In our series, two thirds of patients requiring revision required only a single procedure, but one third required more than one revision.

• Authors: Brian A VanderBrink, Mark P Cain, Martin Kaefer, Kirstan K Meldrum, Rosalia Misseri, Richard C Rink
• Journal: Journal of pediatric surgery (J Pediatr Surg) Vol. 48 Issue 10 Pg. 2134-9 (Oct 2013) ISSN: 1531-5037 [Electronic] United States
• PMID: 24094969 (Publication Type: Evaluation Study, Journal Article)
• Copyright: Copyright © 2013 Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Adult
• Child
• Child, Preschool
• Enema (methods)
• Enterostomy (methods)
• Fecal Incontinence (surgery, therapy)
• Follow-Up Studies
• Humans
• Reoperation (statistics & numerical data)
• Retrospective Studies
• Treatment Outcome
• Young Adult