The colon flap/extension malone antegrade continence enema

An alternative to the monti-malone antegrade continence enema

C. D Anthony Herndon, Mark P. Cain, Anthony J. Casale, Richard C. Rink

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Purpose: In situations where the appendix is not available for the Malone antegrade continence enema (MACE) procedure a Yang-Monti channel or a colon flap conduit can be created. We report our experience with colonic flap conduits used for the MACE. Materials and Methods: A total of 169 MACE procedures were performed between February 1997 and March 2003. In 11 patients 12 colon flaps or cecal extensions were used to construct the MACE conduit. Diagnoses included myelomeningocele (8 patients), caudal regression (1), sacral agenesis (1) and gunshot wound (1). Mean age at creation of MACE was 11.3 years (range 4.4 to 16.9). Seven cecal flaps, 1 descending colon flap and 4 cecal extension flaps were created. Results: Average followup was 22.8 months (range 2.6 to 34.6). Indications for colon flap MACE were appendicovesicostomy (6 patients), short appendix (2), shortened mesentery (1), retrocecal appendix (1), prior appendectomy (1) and right hemicolectomy (1). Initially all patients easily catheterized and flushed the MACE once daily. All 11 patients achieved fecal continence. Complications occurred in 3 cases. One obese patient could not visualize the umbilical stoma and it stenosed, requiring conversion to a spiral Monti-MACE. One patient with a cecal extension had development of a false passage, resulting in complete channel stenosis. One patient had development of stomal leakage, which was successfully treated with dextranomer/hyaluronic acid copolymer injection. Conclusions: A colon flap MACE conduit is a simple technique to provide access to the colon for irrigation. When faced with situations were the appendix is not available for the MACE procedure the colon flap can be a good option.

Original languageEnglish
Pages (from-to)299-302
Number of pages4
JournalJournal of Urology
Volume174
Issue number1
DOIs
StatePublished - Jul 2005

Fingerprint

Enema
Colon
Appendix
Descending Colon
Umbilicus
Meningomyelocele
Gunshot Wounds
Appendectomy
Mesentery
Pathologic Constriction
Injections

Keywords

  • Colon
  • Constipation
  • Enema
  • Fecal incontinence

ASJC Scopus subject areas

  • Urology

Cite this

The colon flap/extension malone antegrade continence enema : An alternative to the monti-malone antegrade continence enema. / Herndon, C. D Anthony; Cain, Mark P.; Casale, Anthony J.; Rink, Richard C.

In: Journal of Urology, Vol. 174, No. 1, 07.2005, p. 299-302.

Research output: Contribution to journalArticle

Herndon, C. D Anthony ; Cain, Mark P. ; Casale, Anthony J. ; Rink, Richard C. / The colon flap/extension malone antegrade continence enema : An alternative to the monti-malone antegrade continence enema. In: Journal of Urology. 2005 ; Vol. 174, No. 1. pp. 299-302.
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abstract = "Purpose: In situations where the appendix is not available for the Malone antegrade continence enema (MACE) procedure a Yang-Monti channel or a colon flap conduit can be created. We report our experience with colonic flap conduits used for the MACE. Materials and Methods: A total of 169 MACE procedures were performed between February 1997 and March 2003. In 11 patients 12 colon flaps or cecal extensions were used to construct the MACE conduit. Diagnoses included myelomeningocele (8 patients), caudal regression (1), sacral agenesis (1) and gunshot wound (1). Mean age at creation of MACE was 11.3 years (range 4.4 to 16.9). Seven cecal flaps, 1 descending colon flap and 4 cecal extension flaps were created. Results: Average followup was 22.8 months (range 2.6 to 34.6). Indications for colon flap MACE were appendicovesicostomy (6 patients), short appendix (2), shortened mesentery (1), retrocecal appendix (1), prior appendectomy (1) and right hemicolectomy (1). Initially all patients easily catheterized and flushed the MACE once daily. All 11 patients achieved fecal continence. Complications occurred in 3 cases. One obese patient could not visualize the umbilical stoma and it stenosed, requiring conversion to a spiral Monti-MACE. One patient with a cecal extension had development of a false passage, resulting in complete channel stenosis. One patient had development of stomal leakage, which was successfully treated with dextranomer/hyaluronic acid copolymer injection. Conclusions: A colon flap MACE conduit is a simple technique to provide access to the colon for irrigation. When faced with situations were the appendix is not available for the MACE procedure the colon flap can be a good option.",
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