Abstract
The aim of the study was to determine which was the optimal side for the conduit to be placed (right or left colon) for antegrade continence enema implantation. Between July 1999 and March 2006, 31 patients underwent the construction of a catheterizable conduit using the Malone principle (MACE) In 22 cases the conduit was re-implanted in the right colon and in 9 cases in the left colon. There were 20 male patients and 11 female patients, with a mean age of 10.23 years. The follow-up period varied from 3 from 83 months (average 25 months). Right and left implantation of the conduit in the colon were compared with regards to the presence of complications, volume of the solution utilized, frequency of colonic lavage, time needed for performing the enema, and degree of satisfaction. One patient with the conduit in the right colon, using the appendix, lost the mechanism after two month follow-up. Thirty patients remain clean and are all capable of performing self-catheterization. No statistically significant differences were found between the groups regarding the variables studied: complications (p = 1.000), solution volume (p = 0.996), time required (p = 0.790) and patient's rating (p = 0.670). The lavage frequency required for patients with the conduit in the right colon may be lower. The MACE principle was considered effective for treating fecal retention and leaks, independent of the implantation site. The success of this surgery appears to be directly related to the patient's motivation and not to the technique utilized.
Highlights
Different diseases can cause intestinal dysfunction and continuous feces soiling
Retrograde enema was the treatment of choice until recently when there was a major step forward made by Malone et al in 1990 (2) with the description of the continent cecal access for antegrade enema
The enema performed in right colon often is long and tedious for handicapped patients, as the volume of washout from the cecum to the rectum is large, especially in neuropathic bowels prone to dolichosigmoid (5)
Summary
Different diseases can cause intestinal dysfunction and continuous feces soiling. And for the treatment to be adequately performed, it is of utmost importance that a cause be found and eventually treated. In cases where the appendix has previously been removed or is required for urological use, the need to construct a new conduit occurs. This has been DFKLHYHGE\XWLOL]LQJDFHFDOÀDS DVLJPRLGÀDS (5) or a segment of the small intestine or colon that KDVEHHQUHFRQ¿JXUHG E\PHDQVRIWKH
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