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Antegrade continence enemas in the management of intractable faecal incontinence
E M Kiely1, N Ade-Ajayi, R Wheeler
1Department of Surgery, Hospital for Children, London, UK.
Insights
The Malone procedure, using the appendix or caecal flap, effectively manages severe faecal incontinence in children. Most patients achieve good continence, with potential benefits for adults.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Colorectal Surgery
Background:
- Severe faecal incontinence significantly impacts children's quality of life.
- The Malone procedure offers a surgical solution for managing faecal incontinence.
Purpose of the Study:
- To evaluate the efficacy and safety of the Malone procedure for children with severe faecal incontinence.
- To assess the use of the appendix or caecal flap as a catheterizable channel.
Main Methods:
- Retrospective review of 27 pediatric patients undergoing the Malone procedure (appendix or caecal flap).
- Antegrade administration of phosphate and saline enemas via the stoma.
- Analysis of stoma complications, continence outcomes, and patient/carer satisfaction.
Main Results:
- The Malone procedure was performed on 27 children (mean age 8.6 years).
- The majority of patients and carers reported very good continence results.
- Complications included stomal stenosis (6 children), small bowel obstruction (1), and one patient discontinued use.
Conclusions:
- The Malone procedure is a safe and effective treatment for severe faecal incontinence in children.
- The appendix and caecal flap serve as reliable catheterizable channels.
- The procedure may be beneficial for adults with refractory faecal incontinence.
Abstract:
The introduction of the Malone procedure has improved the outlook for children with severe faecal incontinence. Phosphate and saline enemas are administered through the exteriorized appendix in antegrade fashion to achieve evacuation and ensure cleanliness. The appendix functions as a non-refluxing catheterizable channel: If it is not available for use, a tubularized caecal flap is a safe alternative. We have constructed Malone stomas using the appendix in 20 patients and another seven patients have undergone the caecal flap modification. The mean age was 8.6 years. Eleven of the patients were boys and 16 (59%) were girls. Six children required dilatation or revision of their stomas for stenosis. One developed small bowel obstruction and another has stopped using the stoma. The results of the continence enemas were considered to be very good by the vast majority of patients and their carers. Our recent experience suggests that bisacodyl may be a valuable adjunct to the antegrade enemas of phosphate and saline. We believe that this procedure may be extended with benefit to adults with serious faecal incontinence in whom standard measures have failed.