The Malone Antegrade Continence Enema

Single Institutional Review

Ahmad H. Bani-Hani, Mark P. Cain, Martin Kaefer, Kirstan K. Meldrum, Shelly King, Cynthia S. Johnson, Richard C. Rink

Research output: Contribution to journalArticle

60 Citations (Scopus)

Abstract

Purpose: We report the long-term outcome of the Malone antegrade continence enema procedure in the treatment of chronic constipation and fecal incontinence in children with neuropathic bowel. Materials and Methods: We performed a retrospective chart review of 256 Malone antegrade continence enema procedures. Patient age at surgery, bowel segment used, location of stoma, number and type of revisions required, and fecal continence were documented and a database was created. Results: A total of 236 patients with at least 6 months of followup are included in this report. There were 172 in situ appendicocecostomies, 23 split appendix channels, 9 appendicocecostomies with cecal extension, 22 Yang-Monti ileocecostomies and 10 colon flap channels performed. A total of 112 males (47%) and 124 females (53%) were included in the study. Median patient age at surgery was 9 years (range 2 to 36) and median followup for the entire cohort was 50 months (6 to 115). A total of 56 surgical revisions were performed in 39 patients (17%). Median time to first revision was 9.5 months (range 1 to 105). Stomal stenosis occurred in 32 patients (14%). Overall, surgical revisions were required in 14% of in situ appendix channels (24 of 172), 22% of split appendix channels (5 of 23), 33% of appendix channels with cecal extension (3 of 9), 18% of Yang-Monti Malone antegrade continence enema channels (4 of 22) and 30% of colon flap channels (3 of 10). Independent of channel technique, surgical revisions were required in 15% of umbilical stomas and 18% of lower quadrant stomas (p = 0.516). Two patients had minimal stomal leakage, and 94% (221 of 236) achieved fecal continence with irrigations. Conclusions: The long-term results of the Malone antegrade continence enema channel in a large cohort of patients with neuropathic bowel and chronic constipation are encouraging. Of the patients 17% will require revision surgery, and patients/parents should be counseled accordingly. In our series in situ appendicocecostomy had the lowest revision rate on long-term followup, although the difference was not statistically significant (p = 0.226).

Original languageEnglish
Pages (from-to)1106-1110
Number of pages5
JournalJournal of Urology
Volume180
Issue number3
DOIs
StatePublished - Sep 2008

Fingerprint

Enema
Appendix
Reoperation
Constipation
Colon
Umbilicus
Fecal Incontinence
Pathologic Constriction
Parents
Databases

Keywords

  • appendix
  • constipation
  • enema
  • spina bifida cystica
  • surgical stomas

ASJC Scopus subject areas

  • Urology

Cite this

Bani-Hani, A. H., Cain, M. P., Kaefer, M., Meldrum, K. K., King, S., Johnson, C. S., & Rink, R. C. (2008). The Malone Antegrade Continence Enema: Single Institutional Review. Journal of Urology, 180(3), 1106-1110. https://doi.org/10.1016/j.juro.2008.05.062

The Malone Antegrade Continence Enema : Single Institutional Review. / Bani-Hani, Ahmad H.; Cain, Mark P.; Kaefer, Martin; Meldrum, Kirstan K.; King, Shelly; Johnson, Cynthia S.; Rink, Richard C.

In: Journal of Urology, Vol. 180, No. 3, 09.2008, p. 1106-1110.

Research output: Contribution to journalArticle

Bani-Hani, AH, Cain, MP, Kaefer, M, Meldrum, KK, King, S, Johnson, CS & Rink, RC 2008, 'The Malone Antegrade Continence Enema: Single Institutional Review', Journal of Urology, vol. 180, no. 3, pp. 1106-1110. https://doi.org/10.1016/j.juro.2008.05.062
Bani-Hani AH, Cain MP, Kaefer M, Meldrum KK, King S, Johnson CS et al. The Malone Antegrade Continence Enema: Single Institutional Review. Journal of Urology. 2008 Sep;180(3):1106-1110. https://doi.org/10.1016/j.juro.2008.05.062
Bani-Hani, Ahmad H. ; Cain, Mark P. ; Kaefer, Martin ; Meldrum, Kirstan K. ; King, Shelly ; Johnson, Cynthia S. ; Rink, Richard C. / The Malone Antegrade Continence Enema : Single Institutional Review. In: Journal of Urology. 2008 ; Vol. 180, No. 3. pp. 1106-1110.
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abstract = "Purpose: We report the long-term outcome of the Malone antegrade continence enema procedure in the treatment of chronic constipation and fecal incontinence in children with neuropathic bowel. Materials and Methods: We performed a retrospective chart review of 256 Malone antegrade continence enema procedures. Patient age at surgery, bowel segment used, location of stoma, number and type of revisions required, and fecal continence were documented and a database was created. Results: A total of 236 patients with at least 6 months of followup are included in this report. There were 172 in situ appendicocecostomies, 23 split appendix channels, 9 appendicocecostomies with cecal extension, 22 Yang-Monti ileocecostomies and 10 colon flap channels performed. A total of 112 males (47{\%}) and 124 females (53{\%}) were included in the study. Median patient age at surgery was 9 years (range 2 to 36) and median followup for the entire cohort was 50 months (6 to 115). A total of 56 surgical revisions were performed in 39 patients (17{\%}). Median time to first revision was 9.5 months (range 1 to 105). Stomal stenosis occurred in 32 patients (14{\%}). Overall, surgical revisions were required in 14{\%} of in situ appendix channels (24 of 172), 22{\%} of split appendix channels (5 of 23), 33{\%} of appendix channels with cecal extension (3 of 9), 18{\%} of Yang-Monti Malone antegrade continence enema channels (4 of 22) and 30{\%} of colon flap channels (3 of 10). Independent of channel technique, surgical revisions were required in 15{\%} of umbilical stomas and 18{\%} of lower quadrant stomas (p = 0.516). Two patients had minimal stomal leakage, and 94{\%} (221 of 236) achieved fecal continence with irrigations. Conclusions: The long-term results of the Malone antegrade continence enema channel in a large cohort of patients with neuropathic bowel and chronic constipation are encouraging. Of the patients 17{\%} will require revision surgery, and patients/parents should be counseled accordingly. In our series in situ appendicocecostomy had the lowest revision rate on long-term followup, although the difference was not statistically significant (p = 0.226).",
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