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Long-term outcomes of a Malone antegrade continence enema (MACE) for the treatment of fecal incontinence or constipation in adults

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Abstract

Purpose

The aim of the study was to assess the long-term outcome of a Malone antegrade continence enema (MACE) procedure for fecal incontinence or constipation in adults.

Methods

This retrospective single-center study assessed the long-term outcome and quality of life (QoL) of patients who underwent a MACE procedure between 2005 and 2014 at the Maastricht University Medical Centre. Success rate was quantified by using Malone’s continence scale. Quality of life was assessed by validated questionnaires covering general quality of life (SF-36 and Karnofsky scale), current pain level (visual analog scale), fecal incontinence (Vaizey incontinence survey), or constipation (Cleveland Clinic Constipation Score).

Results

Based on patients’ records, 22 out of 30 patients (73%; 95% CI 54–87%) were still using their MACE. Mean follow-up was 43 months (SD 25.9) since time of surgery. According to the Malone continence scale, the overall success rate was 37% (95% CI 20.0–53.3). Nine patients developed a postoperative complication. Eighteen out of 22 patients (13 with constipation and 5 with fecal incontinence) returned the QoL questionnaires (82% response rate). Long-term quality of life of patients with a MACE did not differ from the general Dutch population.

Conclusions

In our cohort of patients with fecal incontinence or constipation, MACE resulted in a disappointed overall success rate of 37%. However, it may be indicated in patients who do not prefer more invasive surgical procedures or a definite stoma. The success and morbidity rate should be thoroughly discussed with the patients preoperatively.

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Authors and Affiliations

  1. Department of Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands

    R. Sturkenboom, A. A. van der Wilt, A. Ahmad, P. T. Janssen, L. P. S. Stassen, J. Melenhorst & S. O. Breukink

  2. Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands

    S. M. J. van Kuijk

Authors
  1. R. Sturkenboom
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  2. A. A. van der Wilt
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  3. S. M. J. van Kuijk
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  4. A. Ahmad
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  5. P. T. Janssen
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  6. L. P. S. Stassen
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  7. J. Melenhorst
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Contributions

R. Sturkenboom, M.D., primary investigator, design of study, analysis and interpretation of data, acquisition of data, writing and revising of article, final approval of article. A. A. van der Wilt, M.D., design of the study, writing and revising of article, final approval of article. S. M. J. van Kuijk, Ph.D., analysis and interpretation of data, revising of article, final approval of article. A. Ahmad, M.D., acquisition of data, design of study, revising of article, final approval of article. P. T. Janssen, M.D., Ph.D., design of the study, revising of article, final approval of article. L. P. S. Stassen, M.D., Ph.D., Prof., design of the study, revising of article, final approval of article. J. Melenhorst, M.D., Ph.D., design of the study, revising of article, final approval of article. S. O. Breukink, M.D., Ph.D., corresponding author, primary investigator, design of study, analysis and interpretation of data, acquisition of data, writing and revising of article, final approval of article.

Corresponding author

Correspondence to R. Sturkenboom.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Sturkenboom, R., van der Wilt, A.A., van Kuijk, S.M.J. et al. Long-term outcomes of a Malone antegrade continence enema (MACE) for the treatment of fecal incontinence or constipation in adults. Int J Colorectal Dis 33, 1341–1348 (2018). https://doi.org/10.1007/s00384-018-3088-5

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