Summary
Introduction
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.
Methods
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.
Discussion
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).
Conclusion
We are convinced that this procedure can be incorporated into fecal incontinence/constipation
armamentarium.
Keywords
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References
- Preliminary report: the antegrade continence enema.Lancet. 1990 Nov 17; 336: 1217-1218
- The Macedo-Malone antegrade continence enema procedure: early experience.J Urol. 2005 Apr; 173: 1340-1344
- Left-colon antegrade enema (LACE): long-term experience with the Macedo-Malone approach.Neurourol Urodyn. 2017 Jan; 36: 111-115
- A continent catheterizable ileum-based reservoir.BJU Int. 2000 Jan; 85: 160-162
Article info
Publication history
Published online: December 26, 2021
Accepted:
December 20,
2021
Received in revised form:
December 17,
2021
Received:
September 22,
2021
Identification
Copyright
© 2021 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
