Introduction: Constipation is a chronic condition that is prevalent in children and adults and has a considerable impact on their quality of life. Although there are multiple medications or enema options for this condition, a small subset of patients do not respond to medical therapy and are candidates for surgical management of their constipation by colorectal surgery. Some of these options include colectomy with ileorectal anastomosis, sigmoid colostomy or even loop ileostomy. The Malone Antegrade Continence Enema (MACE) offers an alternative to these patients. This procedure is common in the pediatric population, where pediatric urologists offer MACE in addition to bladder reconstruction procedures for patients with neurogenic bladder and bowel. There is limited evidence on outcomes of this procedure in adults. We present our technique for robotic assisted laparoscopic MACE in addition to our experience and outcomes on MACE in adult patients.
Methods: We describe the technique for robotic assisted laparoscopic MACE in a 45 year old male with neurogenic bowel and functional constipation following a spinal cord injury. Additionally, a retrospective review of adult patients who underwent robotic or open MACE procedures in our tertiary center for neurourology, pelvic floor and reconstructive surgery.
Results: The technique for robotic assisted laparoscopic Malone Antegrade Continent Enema (MACE) is described. Our experience from 2014 to 2021 with six patients who underwent open and minimally invasive MACE for neurogenic bowel and/or functional constipation. Two patients required stoma revision for stenosis at 21 and 13 months. One of them required additional Interventional Guided Cecostomy tube placement due to complete stenosis of the channel and the second patient is currently using the MACE daily.
Conclusions: The Malone Antegrade Continent Enema (MACE) procedure is a feasible option either open or minimally invasive (Robotic or Laparoscopic) for adults with functional constipation or neurogenic bowel before considering colostomy or colon resection.
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