Bowel management with antegrade colonic enema using a Malone or a Monti conduit--clinical results

During this last decade, major surgical improvements have been proposed for the treatment of patients suffering from faecal incontinence or intractable constipation. Between 1996 and 1999, 12 patients mainly presenting with spina bifida were operated for antegrade colonic enema (ACE). In seven cases, a Malone procedure was performed. In 5 cases we used a Monti plasty to create a continent catheterisable conduit. In 4 cases the neoconduit was placed between the transverse colon and the umbilicus. The mean follow-up was 15 months. Bowel control and continence were obtained in 11 cases, postoperatively. One early complete stenosis of the cutaneous stoma occurred, after which the patient did not wish to carry on. Another patient stopped using his ACE stoma after several months because he was able to manage his bowel evacuation voluntarily without requiring an enema. The other ten patients have greatly improved their quality of life. Complications included principally stomal stenosis which can be regularly dilated by the patient himself using the Hegar dilator. Patients with umbilical stoma have a result comparable to patients with Malone procedure. Our series shows that ACE can be performed without an appendix using a Monti plasty. Implantation of the continent conduit in the caecum or in the transverse colon does not modify the overall results of ACE.