Malone antegrade continence enema (mace): a comparison of results using various channel techniques

Introduction To report a single institution's long term results of the various MACE procedures in the treatment of chronic constipation in children with neuropathic bowel. Materials and methods A retrospective chart review of 253 MACE procedures was performed. Age at surgery, channel technique, location of stoma, number and type of revisions required and continence were documented and a database was created. Results 236 patients had at least 6 months follow-up and are included in this report. There were 172 In-situ appendicocecostomies, 23 split appendix channels, 9 appendicocecostomy with cecal extension, 22 Yang-Monti ileocecostomies and 10 colon flap colocecostomies. Mean age at surgery was 10.2 years (2-36 years), and mean follow-up was 50 months (6-115 months). 93% of the patients achieved faecal continence, with no difference between channel techniques. A total of 61 surgical revisions were performed in 56 patients (23.7%). Complications occurred more commonly with the split appendix (26%), and the caecal extension (33%) than the other techniques, but this did not reach statistical significance. There was no significant difference in stomal complications with an umbilical location (17.5%) versus lower abdominal stoma (15%). Mean time to revision for the entire cohort was 18.7 months (1-105 months). Conclusions The long term results of the MACE channel in large cohort of patients with chronic neuropathic constipation are encouraging. Almost 25% of the patients will require revisional surgery and patients/parents should be counselled accordingly. There were no differences in outcomes based on channel technique, though the apppendicocecostomy was associated with the lowest risk of re-operation.