How to achieve a successful Malone antegrade continence enema

The Malone antegrade continence enema (MACE) has proved invaluable in the management of children with faecal incontinence. The authors have reviewed their experience in depth to try and ascertain why some MACEs fail.

The records of 31 children who had a MACE procedure between 1990 and 1995 were reviewed. Their preoperative bowel management, the operative procedure, the postoperative washout regime, and the outcome were assessed. Success was graded either as full, described as totally clean or minor rectal leakage on the night of the washout; partial, described as clean but significant stomal or rectal leakage, occasional major leaks, still wearing protection, and perceived improvement by the parents or child; or failure, described as regular soiling or constipation, no perceived improvement, and the procedure abandoned. There were 18 boys and 13 girls in the series. The mean age at survey was 8.4 years.

Overall success rate was 19 of 31 (61%) with a mean follow-up of 3.25 years. The diagnosis and success rates were: anorectal anomaly 11 (success, 8 of 11, 73%), neuropathic bowel 11 (8 of 11, 73%), chronic constipation 8 (3 of 8, 38%).