Malone Antegrade Continence Enema Stoma in Children with Dysfunctions of Pelvic Organs

Česká verzia

Authors: P. Zerhau; M. Husár; J. Tůma
Authors place of work: Klinika dětské chirurgie, ortopedie a traumatologie FN, Brno, přednosta: prof. MUDr. P. Gál, Ph. D.
Published in the journal: Rozhl. Chir., 2008, roč. 87, č. 11, s. 593-595.
Category: Monothematic special - Original

Summary

Introduction:
Regular large intestine cleansing using rectal enemas in patients with impairment of pelvic organs is technically demanding and, frequently insufficient. Defecation is made easier using Malone antegrade continence enema (MACE), which is based on the same principles as continent vesicostomy.

Aim:
Assessment of up-to-date experience with the MACE in children.

Material and Methodology:
During 2004–2007, the MACE stoma was completed in 7 child patients with spinal dysraphia and severe intestinal dysfunction (meningomyelocele 4x, cerebral palsy 1x, rectal atresia 2x) aged 2–15 y.o.a. In all the subjects, in situ adjusted appendix was used for the construction and, furthermore, continent vesicostomy was performed in two children.

Results:
Seven children were followed up for a period of 10–48 months. The enema volume ranged from 100 to 600 ml and it was administered for 20–30 min. The intestine is cleansed within 20–40 minutes. Frequency of the enemas was once daily in 6 patients and every other day in one girl. Complete continence was achieved and obstipation resolved in 5 children, negligible soiling of a diaper lining persisted in 2 subjects. Stenosis of the appendix stoma in two children was managed by its dilation 3 and 5 months postoperatively.

Conclusion:
MACE stoma facilitates regular cleansing of the large intestine and subsequent establishment of stool continence in patients with spinal dysraphia, as well as in patients with any intestinal dysfunction, requiring regular administration of enemas. It is safe to be used in patients with concomittant continent stoma of the urinary tract.

Key words:
obstipation – stool continence – enema – stoma

Zdroje

1. Malone, P. S.,Ransley, P. G., Kiely, E. M. Preliminary report: the antegrade continence enema. Lancet, 1990, 336: 1217.

2. Calado, A. A.,Macedo, A.,Barroso, U., et al. The Macedo-Malone antegrade continence enema procedure : early experience. J. Urol., 2005, 173: 1340–1344.

3. Liloku, R. B., Mure, P. Y., Braga, L., Basset, T., Mouriquand, P. D. The left Monti-Malone procedure: Preliminary results in seven cases. J. Pediatr. Surg., 2002, 37: 228–231.

4. Herndon, C. D. A., Cain, M. P., Casale, A. J., Rink, R. C. The colon flap/extension Malone antegrade continence enema: an alternative to the Monti-Malone antegrade continence enema. J. Urol., 2005, 174: 299–302.

5. Bargawi, A., de Valdenebro, M., Furness, P. D., Koyle, M. A. Lessons learned from stomal complications in children with cutaneous catheterizable continent stomas. BJU Int., 2004, 94: 1344–1347.

6. Monti, P. R., Lara, R. C., Dutra, M. A., de Carvalho, J. R. New techniques for construction of efferent conduits based on the Mitrofanoff principle. Urology, 1997, 49: 112.

7. Nanigian, D. K., Kurzrock, E. A. Intermediate-term outcome of the simplified laparoscopic antegrade continence enema procedure: less is better. J. Urol., 2008, 179: 299–303.