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Single Incision Laparoscopic Surgery for Malone Antegrade Continent Enema: Optimizing Outcomes in Pediatric Bowel
Ismael Elhalaby1, Irene Isabel P Lim2, Elizaveta Bokova3
1Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; Tanta University Hospital, Faculty of Medicine, Tanta University, Tanta, Egypt.
Background:
Malone antegrade continence enemas (MACE) are increasingly being used to manage severe constipation and fecal incontinence in children. Despite advances in minimally invasive pediatric colorectal surgery, single-incision laparoscopic surgery (SILS) for MACE creation remains relatively unexplored. This study, featuring the largest cohort to date, evaluates the feasibility, safety, and clinical outcomes of SILS MACE creation in children.
Methods:
A single-institution, retrospective review of pediatric patients who underwent SILS MACE creation for severe constipation and/or fecal incontinence between March 2022 and July 2024. Patient demographics, operative data, postoperative complications, and stooling patterns were assessed. Quantitative variables were analyzed using descriptive statistical methods.
Results:
Eighteen patients (10 males, 56 %) underwent SILS MACE creation at a mean age of 10 years (range 4-18) and a median BMI of 17.6 kg/m2 (IQR 16.8-19.6). Preoperative diagnoses included anorectal malformation (n = 9, 50 %), functional constipation (n = 4, 22 %), neurogenic bowel (n = 3, 17 %), and Hirschsprung Disease (n = 2, 11 %). Median operative time was 51 min (IQR 38-67), Postoperative complications included channel prolapse (n = 3, 17 %) and wound infection (n = 2, 11 %). Two patients (11 %) required interventional radiology owing to Mini-ACE® button dislodgment and one patient (5 %) required operative revision for skin-level stenosis. At a median follow-up of 13 months (IQR 7-18), 16 patients (89 %) were clean for stool with successful management through antegrade flushes.
Conclusion:
SILS MACE creation is a safe, feasible, and effective minimally invasive approach for managing severe constipation and fecal incontinence in children. The technique demonstrates potential advantages in cosmetic results and comparable surgical outcomes, offering a viable alternative to the traditional multiport laparoscopic approach.
Type Of Study:
Original Research Article.
Level Of Evidence:
III.
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