Outcomes following Malone antegrade continence enema and their surgical revisions

Brian A. Vanderbrink, Mark P. Cain, Martin Kaefer, Kirstan K. Meldrum, Rosalia Misseri, Richard C. Rink

Research output: Contribution to journalArticlepeer-review

23 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)2134-2139
Number of pages6
JournalJournal of Pediatric Surgery
Volume48
Issue number10
DOIs
StatePublished - Oct 1 2013

Keywords

  • Complications
  • Malone antegrade continence enema
  • Revision
  • Stomal stenosis

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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