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Experience of the MACE procedure at a regional pediatric surgical unit: a 15-year retrospective review.
[hirschsprung disease]
The
Malone
antegrade
continence
enema
(
MACE
)
procedure
is
an
established
treatment
option
for
children
with
constipation
or
fecal
incontinence
.
This
study
retrospectively
analyses
the
management
and
outcomes
of
children
who
underwent
MACE
procedures
at
a
regional
pediatric
surgery
unit
.
Children
who
underwent
a
MACE
procedure
in
our
unit
between
1998
and
2012
were
identified
.
Demographic
and
clinical
data
were
obtained
from
contemporaneous
records
.
Using
the
continence
scale
described
by
Malone
,
overall
outcomes
were
categorized
as
full
,
partial
,
or
failure
(
full
:
totally
clean
or
minor
rectal
leakage
on
night
of
washout
;
partial
:
clean
but
significant
stoma
or
rectal
leakage
,
occasional
major
leak
and
/
or
still
wearing
protection
but
perceived
by
child
or
parent
to
be
an
improvement
;
failure
:
regular
soiling
or
constipation
persisted
,
no
perceived
improvement
,
procedure
was
abandoned
)
.
Data
entry
and
statistical
analysis
were
performed
using
Excel
and
SPSS
(
IBM
Corp
.
,
Armonk
,
New
York
,
United
States
)
.
A
total
of
40
children
(
29
male
)
were
identified
for
inclusion
.
Underlying
diagnoses
were
idiopathic
constipation
(
16
)
,
anorectal
anomalies
(
14
)
and
Hirschprung
's
disease
(
10
)
.
The
MACE
procedure
was
performed
laparoscopically
in
26
cases
and
using
an
open
technique
in
14
cases
.
Mean
age
at
the
time
of
surgery
was
8
.
9
years
(
range
,
3
-
19
years
)
and
mean
follow-up
time
was
6
.
5
years
(
range
,
1
-
10
years
)
.
Outcomes
categorized
as
full
were
62
.
5
%
for
chronic
idiopathic
constipation
(
CIC
)
,
71
.
4
%
for
anorectal
malformation
(
ARM
)
,
and
70
%
for
Hirschsprung
disease
(
HD
)
.
Overall
success
rates
(
full
and
partial
outcomes
combined
)
were
87
.
5
%
for
CIC
,
92
.
8
%
for
ARM
,
100
%
for
HD
,
and
92
.
5
%
for
all
diagnoses
taken
together
.
Eleven
MACE
procedures
(
27
.
5
%
)
were
reversed
,
in
seven
(
17
.
5
%
)
due
to
the
return
of
spontaneous
and
regular
bowel
movements
and
in
four
(
10
%
)
due
to
stomal
problems
.
This
study
identified
a
high
success
rate
(
combining
full
and
partial
outcomes
)
of
92
.
5
%
for
MACE
procedures
within
our
unit
.
An
encouraging
finding
is
that
the
procedure
was
reversed
in
a
significant
proportion
of
patients
following
the
return
of
normal
bowel
habits
.
Diseases
Validation
Diseases presenting
"rectal leakage on night"
symptom
hirschsprung disease
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