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A Malone antegrade continence enema, also known as Malone procedure and by the abbreviation MACE, is a surgical procedure used to create a continent pathway proximal to the anus that facilitates fecal evacuation using enemas.
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Description of procedure
The operation involves connecting the appendix to the abdominal wall and fashioning a valve mechanism that allows catheterization of the appendix, but avoids leakage of stool through it. If the appendix was previously removed or is unusable, a neoappendix can be created with a cecal flap.
Indications
It is done to treat fecal incontinence unresponsive to treatment with medications. It is frequently done with a procedure (Mitrofanoff procedure) to treat urinary incontinence as the two often co-exist, such as in spina bifida.
Surgical alternative
A percutaneous cecostomy tube is an alternative to a MACE. It involves the surgical insertion of a catheter into the cecum for the same goal (of performing enemas). Percutaneous cecostomy procedures, like MACEs, have been performed laparoscopically.
Eponym
It is named after the surgeon (Patrick Malone) who popularized it.
Malone described it as an antegrade continence enema procedure.