Karmarkar, S.J., Sushma, Achugatla, Bangar, A.P., and Krishnan, J. (2023) Is an antireflux procedure necessary for a successful appendicostomy? the simplified Malone antegrade continence enema procedure. Journal of Indian Association of Pediatric Surgeons, 28 (4). pp. 288-292.

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Abstract

Aim: The aim of this study was to present the long-term institutional experience and outcomes of our Malone antegrade continence enema (MACE) procedure using the proximal appendix without any antireflux procedure.

Materials and Methods: A single-center prospective study of 29 children undergoing a simplified Malone antegrade continence enema (SMACE) procedure from 2006 to 2017 was conducted using the appendix, whole or split. The mean follow-up period was 11.5 years (ranging from 5 to 16 years).

Results: In 25 children, the proximal appendix was used, and in 4 cases, the whole appendix was used as a conduit. On follow-up, the MACE channel has been working well in 29/29 patients. Among the complications, seven patients had stomal stenosis, which was managed by home dilatation. There was no reflux of stools seen in any of the patients.

Conclusion: The SMACE procedure, without incorporating an antireflux mechanism, is technically simpler and saves operative time. Most importantly, the results are satisfactory and comparable with procedures using antireflux techniques.

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