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      Is an Antireflux Procedure Necessary for a Successful Appendicostomy? The Simplified Malone Antegrade Continence Enema Procedure

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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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          Most cited references19

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          Preliminary report: the antegrade continence enema.

          B. E. Kiely, P. Colm Malone, P. G. Ransley (1990)
          The principles of antegrade colonic washout and the Mitrofanoff non-refluxing catheterisable channel were combined to produce a continent catheterisable colonic stoma. The intention was that antegrade washouts delivered by this route would produce complete colonic emptying and thereby prevent soiling. The procedure has been successfully carried out in five patients with intractable faecal incontinence.
          Article 0 comments Cited 42 times – based on 0 reviews     Review now
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            New techniques for construction of efferent conduits based on the Mitrofanoff principle.

            P Monti, M Dutra, Alvaro R Lara … (1996)
            Presently, urinary diversion with continence mechanisms based on the Mitrofanoff principle is frequently used. For its construction, the critical issue is related to the choice of efferent conduit; the most widely used are the appendix and the tapered ileum. Here, we present two alternative techniques for construction of tubes applicable to the same function. Ten dogs underwent operations with two different types of tubes constructed through transversal tubularization of small segments of ileum. These tubes were implanted in the bladder. The dogs were followed up for 30 days, during which all were continent. Their tubes were easily catheterized. The techniques described met the criteria defined for an efferent tube to be used according to the Mitrofanoff principle.
            Article 0 comments Cited 28 times – based on 0 reviews     Review now
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              Yang needle tunneling technique in creating antireflux and continent mechanisms.

              Angela Yang (1993)
              A total of 7 patients underwent cystectomy due to bladder malignancy and the ileum was used for lower urinary tract reconstruction (5 underwent bladder substitutions, 1 an internal ileal reservoir and 1 ileal conduit diversion). Antireflux mechanisms were created by submucosally tunneled ureters and in 1 case the continent mechanism was created by a submucosally tunneled ileal tube. In all cases the Yang needle was used, which consists of a needle portion and a forceps portion. The selected position of the ileum for ureteral and ileal tube implantation is injected with normal saline submucosally to form a wheal. The Yang needle is introduced submucosally, guided under the wheal for a certain distance and then directed through the ileal wall. Smooth dilation of the tunnel is achieved with the dilated portion of the needle without laceration of the mucosa. The needle portion is then removed. The ureter or ileal tube is grasped by the forceps portion of the needle and brought through the tunnel to the mucosal side of the ileal plate, followed by mucosa-to-mucosa anastomosis. For all 14 ureteral implantations only 1 ureter had reflux on postoperative radiographic studies and only 1 of 4 hydroureters remained. No additional obstructive lesions or pyelonephritis was noted postoperatively. The patient whose continent mechanism is formed by the submucosal tunneled ileal tube method is continent and free of an appliance. The Yang needle tunneling technique may be a choice in the creation of antireflux and continent mechanisms.
              Article 0 comments Cited 23 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Indian Assoc Pediatr Surg
                Journal ID (iso-abbrev): J Indian Assoc Pediatr Surg
                Journal ID (publisher-id): JIAPS
                Title: Journal of Indian Association of Pediatric Surgeons
                Publisher: Wolters Kluwer - Medknow (India )
                ISSN (Print): 0971-9261
                ISSN (Electronic): 1998-3891
                Publication date (Print): Jul-Aug 2023
                Publication date (Electronic): 11 July 2023
                Volume: 28
                Issue: 4
                Pages: 288-292
                Affiliations
                [1]Senior Consultant Paediatric Surgeon, Department of Pediatric Surgery, Lilavati Hospital and Research Centre, Maharashtra, India
                [1 ]Senior DNB Pediatric Surgery Resident, Department of Pediatric Surgeon, Lilavati Hospital and Research Centre, Maharashtra, India
                [2 ]Junior Consultant Paediatric Surgeon, Department of Pediatric Surgery, Lilavati Hospital and Research Centre, Maharashtra, India
                [3 ]Consultant Paediatric Surgeon, Department of Pediatric Surgery, James Cook University, Townsville, Australia
                Author notes
                Address for correspondence: Dr. S. J. Karmarkar, Department of Paediatric Surgery, Lilavati Hospital and Research Centre, Bandra West, Mumbai - 400 050, Maharashtra, India. E-mail: santoshjk@ 123456yahoo.com
                Article
                Publisher ID: JIAPS-28-288
                DOI: 10.4103/jiaps.jiaps_40_23
                PMC ID: 10455713
                SO-VID: 357a20fd-eb61-46d2-9349-6e7b02e61556
                Copyright © Copyright: © 2023 Journal of Indian Association of Pediatric Surgeons
                License:

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                Date received : 24 February 2023
                Date revision received : 16 April 2023
                Date accepted : 01 May 2023
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Surgery
                Keywords: antireflux,enema,malone antegrade continence enema,simplified malone antegrade continence enema
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: antireflux, enema, malone antegrade continence enema, simplified malone antegrade continence enema

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