T.O. Xu1, R. Hanke1, I. Samuk1, T. Russell1, B. Hisam1, M. Bowser1, L. Tiusaba1, S. Jacobs1, C. Ho1, H. Pohl1, B. Varda1, E. Teeple1, A. Badillo1, M. Levitt1, C. Feng1 1Children’s National Medical Center, Colorectal And Pelvic Reconstruction, Washington, DC, USA
Introduction: Complications following the Malone antegrade continence enema (MACE) procedure have been described to be as high as 30%. We aimed to reassess the incidence of complications for the MACE procedure as experience has been gained and the technique has undergone modifications.
Methods: We performed a single institution, retrospective review (from 1/2010 to 1/2023) of all patients who underwent MACE for treatment refractory constipation and/or soiling. Our primary outcome was any complication that involved either a procedural intervention (operative and/or interventional radiology (IR)) or channel loss. Patient and clinical covariables were compared between patients with and without complications using a univariate analysis. Advancements have included changes to the surgical technique, post-operative management protocols, and routine collaboration with IR.
Results:
188 patients underwent a MACE (176 appendicostomy, 12 neo-appendicostomy; 25 done as a split appendix with a Mitrofanoff) with a median follow up of 17 months (range: 11–26 months). 35 (19%) patients had a major complication including stenosis (8%), device loss (3%), prolapse (3%), leakage (2%), and other (3%). 20 (10%) patients underwent an IR intervention and 17 (9%) required operative intervention (Figure 1). Of those with complications, 22 (63%) patients required only an IR intervention or a minor skin-level revision. Six (3%) patients ultimately experienced channel loss. On univariate analysis, there was no difference in the complication rate when the underlying diagnosis, type of MACE, or use of laparoscopy was considered (all p>0.05).
Conclusion:
In this single institution retrospective study, one in five patients undergoing MACE may experience a major complication. Fortunately, most were amendable to skin level repairs or IR salvage procedures. This apparent improvement in complication rates compared to historical rates may be due to refinements of surgical technique, changes to post-operative management, and collaboration with IR.