The Malone Antegrade Continence Enema (MACE) has been used for over a century in children who have difficulty either passing a bowel movement or who have chronic incontinence. It is often referred to as a Malone procedure, named for the physician who popularized the method about 20 years ago. The procedure allows the emptying of the bowel by using fluid, similar to an enema, that is inserted into a small opening in the side of the abdomen rather than into the rectum.
In the surgery, a small passageway is created between the skin of the abdomen and the colon (large intestine). The passageway is made from the appendix (if the appendix has not been removed) or from a small piece of bowel. A section of small intestine is made into a tube and is reimplanted into the large intestine. This conduit is brought to the surface of the skin via a small opening called a stoma. In many cases, MACE surgery can be done using a laparoscopic method that is minimally invasive.
The goal of the procedure is to provide an easier method to self-administer an enema, promoting privacy and independence.
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