The MACE procedure: experience in the United Kingdom

Abstract

Background/purpose: The Malone Antegrade Continence enema (MACE) procedure has become commonplace in the treatment of patients with faecal incontinence and constipation. To ascertain its place in paediatric practice, the authors surveyed members of the British Association of Paediatric Surgeons (BAPS) to see if they have performed a MACE and continue to do so. The authors also assessed their indications, success rate, and complications.

Methods: Members were asked to give the diagnosis of the patients submitted for surgery before September 1996, the procedure used to constructthe MACE, the rate of failure, and complications encountered.

Results: A total of 300 MACE were reported, and the mean follow-up was 2.4 years. The diagnosis of 273 patients was known: spina bifida, 108; anorectal anomaly, 90; Hirschsprung's disease, 22; constipation, 23; other, 30. The most popular procedure was appendix disconnection and reimplantation. The overall success rate for all diagnoses was 79%. The main complication was stomal stenosis, 30%.

Conclusions: These figures confirm that MACE is a useful operation. Improved patient selection, improvement in techniques, and increasing knowledge regarding continued management should lead to improving results across the country.