Laparoscopic Malone antegrade continence enema

Objective To evaluate laparoscopic appendicostomy in Malone antegrade continence enema (MACE). Methods 25 children with fecal incontinence undergoing MACE were divided into by laparoscopic technique (14 cases) and by laparotomy (11 patients). Results The operation time [(38.3±2.5) min vs. (60.5±3.6) min, t=13.7, P=0.00] was shorter in the laparoscopy group. All patients were followed up for 6 months to 3 years. No intestinal obstruction, fecal leakage in stoma and anal fecal incontinence or soiling happened. In laparoscopy group, the stomal stricture developed in 1 patient. The mucosa prolapse developed in 2 patients. In the laparotomy group, the stomal stricture developed in 2 patients. The mucosa prolapse in 1 patient. The symptom severity scoring for constipation and fecal incontinence after operation decreased in the laparoscopy group (12.1±1.4 vs. 33.7±1.5, t=28.4, P=0.00) vs. laparotomy group (12.5±1.6 vs. 33.3±1.7, t=25.36, P=0.00). While the irrigation volume [(607±151) ml vs. (594±161) ml, t=0.17, P=0.87], MACE scoring (22.1±1.4 vs. 22.0±1.7, t=0.18, P=0.86) and symptom severity scoring for constipation and fecal incontinence (12.1±1.4 vs. 12.5±1.6, t=0.46, P=0.65) were not statistically different. Conclusions The laparoscopic technique can make the MACE easier to operate and less traumatic. Key words: Enema; Fecael incontinence; Laparoscopy