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Malone antegrade continence enema (mace): a comparison of results using various channel techniques
ESPU Meeting 2007
S23
# S03-3 (O)
MACE PROCEDURE: WHICH COLONIC ACCESS ? ´de ´ric HAMEURY, Pierre-Yves MURE, Thierry BASSET and Pierre MOURIQUAND Fre Debrousse Hospital, pediatric surgery, Lyon, FRANCE
PURPOSE
RESULTS
The Malone antegrade continence enema (MACE) is a major advance in treating severe congenital bowel elimination disorders . Various colonic accesses are possible to perform bowel wash outs. Results of right (RACE) and left (LACE) colonic accesses using either appendix, YangMonti tube or Mickey button are compared.
Male to female ratio was 0.77, with a median age of 13 years (range from 2 to 21 years) and a median follow up of 31 months (6 e 132 months). Indications were mainly spina bifida (19 patients). Twenty three achieved faecal continence, 6 failed (19%), 4 needed nappies for inadequate continence (2 with urinary incontinence), and 2 had a colostomy . Mean irrigation volume was 400 ml (200 - 1000 ml) 2 to 3 times a week. Two patients became clean without irrigation. Duration of bowel wash out was significantly shorter in the 15 LACE (mean 27mn; 10-45mn) compared to the
MATERIAL AND METHODS It is a retrospective study of 32 MACE procedures performed in our department between May 1994 and April 2006.
16 RACE (mean 45mn; 15-120 min). Four major complications (fistula, peritonitis, abscess and obstruction) and 8 minor complications (leakage, stenosis) occurred with 11 Monti tubes and 6 Mickey buttons. No major complications and 6 minor complications (leakage, false passage) were recorded in 14 appendix MACE.
CONCLUSIONS Conclusion: The LACE procedure provides shorter duration of enemas and less abdominal discomfort whereas the appendix access has less complications than the other types of colonic access.
# S03-4 (PP)
MALONE ANTEGRADE CONTINENCE ENEMA (MACE): A COMPARISON OF RESULTS USING VARIOUS CHANNEL TECHNIQUES Mark P. CAIN, M.D. FAAP, Ahmad H. BANI-HANI, Martin KAEFER, Anthony J. CASALE, Shelly KING and Richard C. RINK James Whitcomb Riley Hospital for Children, Indiana University, Division of Pediatric Urology, Indiananpolis, USA
INTRODUCTION
RESULTS
To report a single institution’s long term results of the various MACE procedures in the treatment of chronic constipation in children with neuropathic bowel.
236 patients had at least 6 months followup and are included in this report. There were 172 In-situ appendicocecostomies, 23 split appendix channels, 9 appendicocecostomy with cecal extension, 22 Yang-Monti ileocecostomies and 10 colon flap colocecostomies. Mean age at surgery was 10.2 years (2-36 years), and mean follow-up was 50 months (6-115 months). 93% of the patients achieved faecal continence, with no difference between channel techniques. A total of 61 surgical revisions were performed in 56 patients (23.7%). Complications occurred more commonly with the split appendix (26%), and the caecal extension (33%) than the other techniques, but this did not reach
MATERIALS AND METHODS A retrospective chart review of 253 MACE procedures was performed. Age at surgery, channel technique, location of stoma, number and type of revisions required and continence were documented and a database was created.
statistical significance. There was no significant difference in stomal complications with an umbilical location (17.5%) versus lower abdominal stoma (15%). Mean time to revision for the entire cohort was 18.7 months (1-105 months).
CONCLUSIONS The long term results of the MACE channel in large cohort of patients with chronic neuropathic constipation are encouraging. Almost 25% of the patients will require revisional surgery and patients/parents should be counselled accordingly. There were no differences in outcomes based on channel technique, though the apppendicocecostomy was associated with the lowest risk of reoperation.
S23
# S03-3 (O)
MACE PROCEDURE: WHICH COLONIC ACCESS ? ´de ´ric HAMEURY, Pierre-Yves MURE, Thierry BASSET and Pierre MOURIQUAND Fre Debrousse Hospital, pediatric surgery, Lyon, FRANCE
PURPOSE
RESULTS
The Malone antegrade continence enema (MACE) is a major advance in treating severe congenital bowel elimination disorders . Various colonic accesses are possible to perform bowel wash outs. Results of right (RACE) and left (LACE) colonic accesses using either appendix, YangMonti tube or Mickey button are compared.
Male to female ratio was 0.77, with a median age of 13 years (range from 2 to 21 years) and a median follow up of 31 months (6 e 132 months). Indications were mainly spina bifida (19 patients). Twenty three achieved faecal continence, 6 failed (19%), 4 needed nappies for inadequate continence (2 with urinary incontinence), and 2 had a colostomy . Mean irrigation volume was 400 ml (200 - 1000 ml) 2 to 3 times a week. Two patients became clean without irrigation. Duration of bowel wash out was significantly shorter in the 15 LACE (mean 27mn; 10-45mn) compared to the
MATERIAL AND METHODS It is a retrospective study of 32 MACE procedures performed in our department between May 1994 and April 2006.
16 RACE (mean 45mn; 15-120 min). Four major complications (fistula, peritonitis, abscess and obstruction) and 8 minor complications (leakage, stenosis) occurred with 11 Monti tubes and 6 Mickey buttons. No major complications and 6 minor complications (leakage, false passage) were recorded in 14 appendix MACE.
CONCLUSIONS Conclusion: The LACE procedure provides shorter duration of enemas and less abdominal discomfort whereas the appendix access has less complications than the other types of colonic access.
# S03-4 (PP)
MALONE ANTEGRADE CONTINENCE ENEMA (MACE): A COMPARISON OF RESULTS USING VARIOUS CHANNEL TECHNIQUES Mark P. CAIN, M.D. FAAP, Ahmad H. BANI-HANI, Martin KAEFER, Anthony J. CASALE, Shelly KING and Richard C. RINK James Whitcomb Riley Hospital for Children, Indiana University, Division of Pediatric Urology, Indiananpolis, USA
INTRODUCTION
RESULTS
To report a single institution’s long term results of the various MACE procedures in the treatment of chronic constipation in children with neuropathic bowel.
236 patients had at least 6 months followup and are included in this report. There were 172 In-situ appendicocecostomies, 23 split appendix channels, 9 appendicocecostomy with cecal extension, 22 Yang-Monti ileocecostomies and 10 colon flap colocecostomies. Mean age at surgery was 10.2 years (2-36 years), and mean follow-up was 50 months (6-115 months). 93% of the patients achieved faecal continence, with no difference between channel techniques. A total of 61 surgical revisions were performed in 56 patients (23.7%). Complications occurred more commonly with the split appendix (26%), and the caecal extension (33%) than the other techniques, but this did not reach
MATERIALS AND METHODS A retrospective chart review of 253 MACE procedures was performed. Age at surgery, channel technique, location of stoma, number and type of revisions required and continence were documented and a database was created.
statistical significance. There was no significant difference in stomal complications with an umbilical location (17.5%) versus lower abdominal stoma (15%). Mean time to revision for the entire cohort was 18.7 months (1-105 months).
CONCLUSIONS The long term results of the MACE channel in large cohort of patients with chronic neuropathic constipation are encouraging. Almost 25% of the patients will require revisional surgery and patients/parents should be counselled accordingly. There were no differences in outcomes based on channel technique, though the apppendicocecostomy was associated with the lowest risk of reoperation.