Robotic-assisted laparoscopic MACE

The creation of a Malone antegrade continence enema (MACE) channel is an option to treat patients with neurologic conditions that result in fecal soiling or intractable constipation. It is typically performed in an open fashion through a midline incision or laparoscopically. The laparoscopic technique typically involves bringing the tip of the appendix to the skin whereas the open technique allows for imbrication of the cecum around the channel, which may improve continence and decrease the risk of perforation. Herein, we demonstrate a technique to create a MACE using both robotic-assisted and laparoscopic techniques that allows for imbrication of the channel without requiring an open incision.

Three robotic ports are placed in the midline and a fourth port is placed in the right lower quadrant at the location of the MACE stoma. Two mesenteric fenestrations are made along the appendix in order to imbricate the cecum around the channel. The tip of the appendix is then brought to through the laparoscopic port in the right lower quadrant, and matured to the skin.

The MACE procedure can safely be performed using a robotic-assisted technique that allows for imbrication of the cecum around the channel and improved cosmesis.