Long-term outcomes of a Malone antegrade continence enema (MACE) for the treatment of fecal incontinence or constipation in adults

R. Sturkenboom*, A. A. van der Wilt, S. M. J. van Kuijk, A. Ahmad, P. T. Janssen, L. P. S. Stassen, J. Melenhorst, S. O. Breukink

*Corresponding author for this work

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Abstract

Purpose The aim of the study was to assess the long-term outcome of a Malone antegrade continence enema (MACE) procedure for fecal incontinence or constipation in adults. Methods This retrospective single-center study assessed the long-term outcome and quality of life (QoL) of patients who underwent a MACE procedure between 2005 and 2014 at the Maastricht University Medical Centre. Success rate was quantified by using Malone's continence scale. Quality of life was assessed by validated questionnaires covering general quality of life (SF-36 and Karnofsky scale), current pain level (visual analog scale), fecal incontinence (Vaizey incontinence survey), or constipation (Cleveland Clinic Constipation Score). Results Based on patients' records, 22 out of 30 patients (73%; 95% CI 54-87%) were still using their MACE. Mean follow-up was 43 months (SD 25.9) since time of surgery. According to the Malone continence scale, the overall success rate was 37% (95% CI 20.0-53.3). Nine patients developed a postoperative complication. Eighteen out of 22 patients (13 with constipation and 5 with fecal incontinence) returned the QoL questionnaires (82% response rate). Long-term quality of life of patients with a MACE did not differ from the general Dutch population. Conclusions In our cohort of patients with fecal incontinence or constipation, MACE resulted in a disappointed overall success rate of 37%. However, it may be indicated in patients who do not prefer more invasive surgical procedures or a definite stoma. The success and morbidity rate should be thoroughly discussed with the patients preoperatively.
Original languageEnglish
Pages (from-to)1341-1348
Number of pages8
JournalInternational Journal of Colorectal Disease
Volume33
Issue number10
DOIs
Publication statusPublished - 1 Oct 2018

Keywords

  • Constipation
  • Fecal incontinence
  • Malone antegrade continence enema
  • Quality of life
  • SLOW-TRANSIT CONSTIPATION
  • HEALTH SURVEY SF-36
  • KARNOFSKY PERFORMANCE STATUS
  • SACRAL NERVE-STIMULATION
  • QUALITY-OF-LIFE
  • COLONIC ENEMA
  • RELIABILITY
  • EXPERIENCE
  • MANAGEMENT
  • DISORDERS

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