Malone antegrade continence enema

A Malone antegrade continence enema is a surgical procedure used to create a continent pathway proximal to the anus that facilitates fecal evacuation using enemas.

Malone antegrade continence enema
The vermiform appendix is typically used in the Malone antegrade continence enema.
Other namesMACE, Malone procedure, ACE procedure, continent appendicostomy, Malone antegrade colonic enema

Description

The operation involves connecting the appendix to the abdominal wall and fashioning a valve mechanism that allows catheterization of the appendix, but avoids leakage of stool through it. If the appendix was previously removed or is unusable, a neoappendix can be created with a cecal flap.[1]

Indications

It is done to treat fecal incontinence unresponsive to treatment with medications. It is frequently done with a procedure (Mitrofanoff procedure) to treat urinary incontinence as the two often co-exist,[2] such as in spina bifida.

Cecostomy tube alternative

A percutaneous cecostomy tube (C-tube)[3] is an alternative to a MACE. It involves the surgical insertion of a catheter into the cecum for the same goal (of performing enemas). Percutaneous cecostomy procedures, like MACEs, have been performed laparoscopically.

Eponym

The procedure is named after the surgeon Padraig Malone who helped popularized it in the 1990s and described it with co-authors as the antegrade continence enema procedure.[4]

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See also

References
  1. Weiser AC, Stock JA, Hanna MK (June 2003). "Modified cecal flap neoappendix for the Malone antegrade continence enema procedure: a novel technique". J. Urol. 169 (6): 2321–4. doi:10.1097/01.ju.0000067286.80366.42. PMID 12771790.
  2. Teichman JM, Rogenes VJ, Barber DB (1997). "The utility of the Malone antegrade continence enema for urologists". Tech Urol. 3 (1): 30–3. PMID 9170222.
  3. What is a Cecostomy Catheter? cecostomy.com. URL: http://www.cecostomy.com/Introduction/cecostomy.htm Archived 2000-01-26 at the Wayback Machine. Accessed on: August 9, 2008.
  4. Roberts JP, Moon S, Malone PS (March 1995). "Treatment of neuropathic urinary and faecal incontinence with synchronous bladder reconstruction and the antegrade continence enema procedure". Br J Urol. 75 (3): 386–9. doi:10.1111/j.1464-410X.1995.tb07354.x. PMID 7735806.
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