Malone antegrade colonic enema procedure in children [Çocuklarda Malone antegrad kolon lavmani]

Aim: Fecal incontinence in patients with spina bifida, high anorectal and cloacal malformations and trauma may cause challenging medical and psychologic problems. In recent years, Malone Antegrade Colonic Enema (MACE) procedure has been proposed to achieve fecal continence in these patients. In this study, we report the results of MACE procedure in children with fecal incontinence. Method: The records of 16 patients treated by MACE procedure between the years 1995-2002 were analyzed retrospectively. Mean age at surgery was 9 (5-13) years. The appendix (n=14), and in patients with previous appendectomy, cecal tube (n=2) were used for the construction of the stoma. Simultaneous construction of Mitrofanoff stoma for urinary diversion was performed in 7 patients and in 5 of these patients the appendix was divided into two pieces and the proximal portion was used for MACE. The cutaneous stomal anastomosis were constructed by using VQZ-flap technique. Results: Mean follow up was 17.3 (2-57) months. All cases perform daily enemas and all are continent for 1-2 days. Stenosis of the stoma in 3 cases and perforation of the appendix in 2 patients were the postoperative complications. Conclusion: MACE procedure has satisfactory results in children with fecal incontinence. Therefore, it is the recommended as a safe and effective method of treatment in such patients.