Video Bank| Volume 18, ISSUE 1, P98-99, February 2022

The Macedo-Malone antegrade colonic enema: A minimal invasive technique that precludes appendix use

Published:December 26, 2021DOI:



      Antegrade continence enema (ACE) is recommended for patients with fecal incontinence/constipation refractory to conservative management. The Malone ACE utilizes the appendix as a catheterizable channel whereas the Macedo–Malone (MM) precludes the use of the appendix. We aimed to illustrate the MM procedure.


      The left colon is brought out through a small transverse incision on the upper left abdomen and a 3-cm transverse flap in a tenia is created. A 12-Fr silicone Foley catheter is placed on the mucosal surface of the flap to allow creating a tubular conduit. After closure of the anterior wall colonic, the continence valve mechanism is produced by embedding the tube over a serous lined tunnel created by interrupted sutures. The distal portion of the tube is anastomosed into a V shape to the skin flap to avoid stoma stenosis.


      The advantage of this technique is the all-the time availability for not requiring the appendix which some authors prefer to use for urinary reconstruction. In a previous study, we have shown that the MM produces a high rate (89%) of fecal continence (Mean follow-up: 75 months).


      We are convinced that this procedure can be incorporated into fecal incontinence/constipation armamentarium.


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