THE MALONE ANTEGRADE COLONIC ENEMA PROCEDURE - OUTCOME AND LESSONS OF6 YEARS EXPERIENCE

The successful management of faecal incontinence can dramatically impr ove the quality of life of affected children. The introduction of the non-refluxing, catheterisable appendico-caecostomy provides the opport unity to treat previously resistant patients. Over a B-year period, 29 children had a Malone antegrade continent stoma for enema administrat ion (MACE). Incontinence was related to spina bifida in 12 children, a no-rectal anomaly in 12, Hirschprung's disease in 2, followed excision of a pelvic tumour in 2, and was secondary to intractable chronic con stipation in 1. The conduit was fashioned from the appendix (20), a ca ecal tube (8), or a gastric tube (1). Surgical complications were stom al stenosis (11), wound infection (1), anastomotic leak (1), MACE stom a prolapse (1), and a pressure sore (1). Colonic irrigation was achiev ed with washouts of saline (24), saline plus phosphate (4), and saline plus Picolax (1). Twenty-three patients have complete control of bowe l function, but 4 still soil. Two remain incontinent, 1 of whom is sti ll being instructed. One child subsequently had a colostomy, but still uses the MACE stoma. Successful bowel management requires motivation, dedication, commitment, and the input of a clinical nurse specialist. The MACE is a relatively straightforward operative procedure that pro vides an effective washout technique that is acceptable to both parent s and children.