The Malone Antegrade Continence Enema (MACE) principle in children: is it important if the conduit is implanted in the left or the right colon?

Objective: The aim of the study was to determine which was the optimal side for the conduit to be placed (right or left colon) for antegrade continence enema implantation.

Materials And Methods: Between July 1999 and March 2006, 31 patients underwent the construction of a catheterizable conduit using the Malone principle (MACE) In 22 cases the conduit was re-implanted in the right colon and in 9 cases in the left colon. There were 20 male patients and 11 female patients, with a mean age of 10.23 years. The follow-up period varied from 3 from 83 months (average 25 months). Right and left implantation of the conduit in the colon were compared with regards to the presence of complications, volume of the solution utilized, frequency of colonic lavage, time needed for performing the enema, and degree of satisfaction.

Results: One patient with the conduit in the right colon, using the appendix, lost the mechanism after two month follow-up. Thirty patients remain clean and are all capable of performing self-catheterization. No statistically significant differences were found between the groups regarding the variables studied: complications (p = 1.000), solution volume (p = 0.996), time required (p = 0.790) and patient's rating (p = 0.670). The lavage frequency required for patients with the conduit in the right colon may be lower.

Conclusion: The MACE principle was considered effective for treating fecal retention and leaks, independent of the implantation site. The success of this surgery appears to be directly related to the patient's motivation and not to the technique utilized.