Background/Purpose: The Malone antegrade continence enema (MACE) has p
roved invaluable in the management of children with faecal incontinenc
e. The authors have reviewed their experience in depth to try and asce
rtain why some MACEs fail. Methods: The records of 31 children who had
a MACE procedure between 1990 and 1995 were reviewed. Their preoperat
ive bowel management, the operative procedure, the postoperative washo
ut regime, and the outcome were assessed. Success was graded either as
full, described as totally clean or minor rectal leakage on the night
of the washout; partial, described as clean but significant stomal or
rectal leakage, occasional major leaks, still wearing protection, and
perceived improvement by the parents or child; or failure, described
as regular soiling or constipation, no per perceived improvement, and
the procedure abandoned, There were 18 boys and 13 girls in the series
. The mean age at survey was 8.4 years. Results: Overall success rate
was 19 of 31 (61%) with a mean follow-up of 3.25 years. The diagnosis
and success rates were: anorectal anomaly 11 (success, 8 of 11, 73%),
neuropathic bowel 11 (8 of 11, 73%), chronic constipation 8 (3 of 8, 3
8%). Copyright (C) 1998 by W.B. Saunders Company.