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Related Experiment Video

Updated: Sep 19, 2025

Barnes Maze Testing Strategies with Small and Large Rodent Models
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How to avoid a Monti.

Filipa Jalles1, Thomas O Xu1, Ismael Elhalaby1

  • 1Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, DC, USA.

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|June 17, 2025
PubMed
Summary

This study presents novel surgical techniques for antegrade continence enema (ACE) creation, prioritizing appendix preservation for the Mitrofanoff procedure and simplifying complex reconstructions. These methods aim to reduce complications and offer flexible ACE channel options.

Keywords:
Antegrade continence enema (ACE)Malone appendicostomyMitrofanoffMontiNeo-MaloneSplit-appendix technique

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Area of Science:

  • Urology
  • Pediatric Surgery
  • Surgical Innovation

Background:

  • Antegrade continence enema (ACE) and Mitrofanoff procedures are vital for managing fecal and urinary incontinence.
  • Traditional Monti techniques can be complex and associated with complications.
  • Preserving the appendix for the Mitrofanoff while creating an ACE channel presents surgical challenges.

Purpose of the Study:

  • To highlight innovative surgical approaches for antegrade continence enema (ACE) creation.
  • To present techniques that preserve the appendix for the Mitrofanoff procedure.
  • To streamline combined reconstructions and reduce operative complexity and complications.

Main Methods:

  • Split appendix technique for dual use.
  • Extension of the appendiceal base for improved length and viability.
  • Neo-Malone appendicostomy for a dedicated ACE channel.
  • Non-plicated appendicocecostomy for staged reconstruction.

Main Results:

  • These techniques facilitate the use of the appendix for both Mitrofanoff and ACE.
  • Reduced operative complexity and potential for fewer complications compared to traditional methods.
  • Provided options for simultaneous or asynchronous creation of the ACE channel.

Conclusions:

  • Novel surgical strategies enhance the utility of the appendix in reconstructive urology.
  • These approaches offer improved outcomes and flexibility in managing incontinence.
  • The presented techniques provide valuable alternatives for ACE creation and Mitrofanoff procedures.