Long-term results of Malone's procedure with antegrade irrigation for severe chronic constipation

Abstract

The Malone antegrade colonic enema (MACE) procedure is a minimally invasive treatment for severe constipation, and the objective of the present study was to assess the long-term results and quality of life in patients undergoing such colonic irrigation. Twenty-five adult patients underwent MACE between 1995 and 2002 for chronic constipation. After a mean follow-up duration of 55+/-36 months, the patients answered questionnaires to assess stoma usage, constipation score (KESS) and quality of life (GIQLI). The mean quality-of-life scores for these patients was 83+/-28 (normal: 125), while their mean constipation score was 19+/-9 (normal: <7). Twelve patients stopped the irrigations, and eight underwent further surgical procedures, specifically, total colectomy with ileostomy (n=2), ileorectal anastomosis (n=3) or segmental colectomy (n=3). Finally, five patients had permanent stoma. The 13 remaining patients continued to perform irrigations (4.6 per week). The patients' mean KESS score was 18.3+/-8 (normal: <7), and the mean GIQLI score was 98+/-20 (normal: 125). Continence status had no influence on success. In our series, MACE was successful in half the patients who were, thus, able to avoid more aggressive approaches. However, when MACE failed, other surgical procedures were often required.