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[Appendicostomy in the treatment of severe defecation disorders in children]
Susanne Morsing Krogsgaard1, Mette Dia Milling, Niels Qvist
1Odense Universitetshospital, Kirurgisk Afdeling A, Odense C.
Insights
The Malone antegrade colonic enema (MACE) procedure significantly improves fecal incontinence and constipation in children. While most patients experience enhanced quality of life and satisfaction, potential complications require careful consideration.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Colorectal Surgery
Context:
- The Malone antegrade colonic enema (MACE) is a surgical option for managing severe fecal incontinence and intractable constipation in pediatric patients.
- Odense University Hospital has utilized the MACE procedure as a treatment modality.
Purpose:
- To retrospectively evaluate the efficacy and patient outcomes of the Malone antegrade colonic enema (MACE) procedure in children.
- To assess improvements in colonic function, quality of life, and patient satisfaction following MACE.
Summary:
- A retrospective review of 32 pediatric patients (mean age 8.7 years) undergoing MACE for fecal incontinence or constipation was conducted.
- The majority of patients (81%) reported improvement, with 46% achieving complete continence. Patient satisfaction and well-being scores were high (mean 9/10).
- Complications included stomal stenosis (41%) and leakage (62%), with 54% experiencing abdominal pain.
Impact:
- The MACE procedure demonstrates success in improving stool patterns, quality of life, and overall satisfaction for children with severe fecal incontinence or intractable constipation.
- Despite its success, the MACE procedure is associated with notable complications, necessitating careful patient selection and management.
- This study highlights the MACE as a valuable, albeit imperfect, intervention for improving pediatric functional bowel disorders.
Introduction:
The Malone antegrad colonic enema (MACE) has been an option in the treatment of children with severe faecal incontinence or intractable constipation at Odense University Hospital.
Materials And Methods:
We did a retrospective review of 32 case records and questionnaires completed by the patients. Pre-existing conditions included anorectal anomaly, myelomeningocele, Hirschsprung's disease and idiopathic constipation. The mean age at operation was 8.7 years (range 4-16 years), and the mean follow-up time was 2.5 years (range 1-8 years).
Results:
Of the 32 patients, 31 returned the questionnaire. Three children had obtained satisfactory colonic function, and 2 patients had had a colostomy because of an unsatisfactory result. Of the remaining 26 patients, all reported improvement and 46% were completely clean. Complications related to the stoma included stomal stenosis (41%) and stomal leakage (62%), and 54% had experienced some degree of abdominal pain during the procedure. The patients' satisfaction with the MACE procedure and their improvement in general well-being was evaluated on a scale from 1 to 10 (1 = no satisfaction/improvement; 10 = fantastic satisfaction/improvement). The results ranged from 5 to 10 (mean 9). The same results were achieved regarding well-being.
Conclusion:
The MACE is a successful management option in children with faecal incontinence or intractable constipation. Patients' stool pattern, quality of life and satisfaction are greatly improved. However, the method is not without problems.
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