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Erschienen in: Pediatric Surgery International 7/2004

01.07.2004 | Original Article

MACE or caecostomy button for idiopathic constipation in children: a comparison of complications and outcomes

verfasst von: S. Cascio, M. E. Flett, M. De la Hunt, A. M. Barrett, B. Jaffray

Erschienen in: Pediatric Surgery International | Ausgabe 7/2004

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Abstract

The Malone antegrade enema (MACE) and the caecostomy button (CB) are two methods of achieving colonic lavage in constipated children with faecal soiling. We reviewed our experience with the MACE and CB, aiming to compare results, complications, and outcomes. Between June 1998 and August 2002, 37 children (15 boys) underwent MACE and 12 children (9 boys) underwent CB for idiopathic constipation that had failed conventional treatment. Rectal biopsy was ganglionic in all cases. Mean age at surgery was 9.9 years for the MACE patients and 9.8 years for the CB patients. All children are under continuous review, and mean follow-up is 18 months. Statistical analysis of proportions used Fisher’s exact test. Soiling stopped completely in 30 children with MACE and in 9 with CB. Occasional soiling is still present in two children with a CB and in one with MACE. One child with a CB had resumed regular bowel activity, and the CB was removed. MACE failed in 5 (14%) patients because of ineffective colonic lavage, and in one patient (3%) the appendix was replaced by a CB because of perforation of the appendicostomy. CB failed in one patient (8%) because of faecal leak around the button; the child was subsequently converted to MACE (P=>0.5). Complications requiring operative intervention were seen in 9 (24%) of the 37 patients who underwent MACE and none of the 12 patients who underwent CB (P=0.09). The main complication requiring surgical intervention was stoma stenosis (11%). Complications not requiring operative intervention were seen in 7 (19%) patients after MACE and 11 (92%) of the 12 patients who underwent CB (P<0.001). The MACE and CB procedures are reliable and effective with high success rates. The MACE has a higher incidence of complications requiring operative intervention. Conversely, complications not requiring operative intervention are more frequent with CB. CB is a safe and effective alternative to MACE in children with faecal soiling.
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Metadaten
Titel
MACE or caecostomy button for idiopathic constipation in children: a comparison of complications and outcomes
verfasst von
S. Cascio
M. E. Flett
M. De la Hunt
A. M. Barrett
B. Jaffray
Publikationsdatum
01.07.2004
Verlag
Springer-Verlag
Erschienen in
Pediatric Surgery International / Ausgabe 7/2004
Print ISSN: 0179-0358
Elektronische ISSN: 1437-9813
DOI
https://doi.org/10.1007/s00383-004-1220-9

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