Pre-operative risk factors for stomal stenosis with Malone antegrade continence enema procedures.


eMediNexus    09 January 2018

The Malone antegrade continence enema (MACE) procedure remains an effective tool in providing independence to pediatric patients with refractory constipation. Unfortunately, MACE stomal stenosis (SS) continues to be a frustrating complication. A recent study published in the Journal of Pediatric Urology aimed to perform a retrospective risk analysis of the pre-operative factors associated with postoperative stomal stenosis. This review included 39 consecutive patients treated with MACE by a single surgeon. Collected data included the type of channel construction, stoma site, pre-operative body mass index (BMI) z-score, pre-operative diagnosis, and development of SS. It was observed that stomal stenosis developed in 49% patients with an average follow-up of 4.7 years. Ninety percent of patients had a diagnosis of myelomeningocele, and there was no significant difference in gender distribution. Meanwhile, the distribution types of MACE efferent limbs consisted of appendicocecostomy in 51%; cecal-wall flap in 41%; and ileocecostomy in 8% patients. Additionally, neither the type of efferent limb, nor stomal location were significant predictors of postoperative SS. Whereas pre-operative obesity (BMI ≥95%) was found to be a significant risk of SS. Hence, it was concluded that neither a cecal wall flap nor the stomal site location contributed to SS. However, obesity was the only identified statistically significant risk factor that led to SS.

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