Skip to main content
SpringerLink
Log in

Use of Malone Antegrade Continence Enema in Patients With Perineal Colostomy After Rectal Resection

  • Published:
Diseases of the Colon & Rectum

PURPOSE

Abdominoperineal resection, with iliac colostomy, remains the gold standard treatment for very low-lying rectal cancer, but it alters patients’ quality of life. Alternatives to iliac colostomy need to be experimented. Antegrade enemas via a cecal access (Malone operation) obtains a colonic emptying and improves continence for incontinent patients. Continence and quality of life after abdominoperineal resection and perineal colostomy associated to a Malone antegrade continence enema were studied.

METHODS

After abdominoperineal resection for cancer, 18 patients had a digestive reconstruction by perineal colostomy and Malone antegrade continence enema. Patients performed antegrade enemas every 24 to 48 hours with tap water. After six months, continence (Cleveland Clinic score) and quality of life (Fecal Incontinence Quality of Life scale) were recorded.

RESULTS

Morbidity was 5 percent (1 appendix necrosis). All patients could perform antegrade enemas by themselves. Mean continence score was 6.41/20 (standard error, 2.31). Fecal Incontinence Quality of Life scores were: lifestyle 3.18/4 (standard error, 0.83); coping/behavior 2.99/4 (standard error, 0.83); depression/self-perception 3.11/4 (standard error, 0.83); embarrassment 2.84/4 (standard error, 0.63).

CONCLUSIONS

After abdominoperineal resection, Malone antegrade continence enema associated to perineal colostomy provided an acceptable continence. It preserved patients’ body image and resulted in a satisfying quality of life. It could become an alternative to iliac colostomy in selected patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1.

Similar content being viewed by others

REFERENCES

  1. A Frigell M Ottander H Stenbeck L Pahlman (1990) ArticleTitleQuality of life of patients treated with abdominoperineal resection or anterior resection for rectal carcinoma Ann Chir Gynaecol 79 26–30 Occurrence Handle1:STN:280:DyaK3c3ptVaisA%3D%3D Occurrence Handle2357050

    CAS  PubMed  Google Scholar 

  2. RS McLeod (2001) ArticleTitleComparison of quality of life in patients undergoing abdominoperineal extirpation or anterior resection for rectal cancer Ann Surg 233 157–8 Occurrence Handle1:STN:280:DC%2BD3M7ls1SnsQ%3D%3D Occurrence Handle11176119

    CAS  PubMed  Google Scholar 

  3. A Karadag BB Mentes A Uner O Irkorucu S Ayaz S Ozkan (2003) ArticleTitleImpact of stomatherapy on quality of life in patients with permanent colostomies or ileostomies Int J Colorectal Dis 18 234–8 Occurrence Handle12673489

    PubMed  Google Scholar 

  4. RA Gamagami P Chiotasso F Lazorthes (1999) ArticleTitleContinent perineal colostomy after abdominoperineal resection: outcome after 63 cases Dis Colon Rectum 42 626–30 Occurrence Handle1:STN:280:DyaK1M3nsVCrsA%3D%3D Occurrence Handle10344685

    CAS  PubMed  Google Scholar 

  5. PS Malone PG Ransley EM Kiely (1990) ArticleTitlePreliminary report: the antegrade continence enema Lancet 336 1217–8 Occurrence Handle1:STN:280:DyaK3M%2FktFehsg%3D%3D Occurrence Handle1978072

    CAS  PubMed  Google Scholar 

  6. EW Gerharz V Vik G Webb CR Woodhouse (1997) ArticleTitleThe in situ appendix in the Malone antegrade continence enema procedure for faecal incontinence Br J Urol 79 985–6 Occurrence Handle1:STN:280:DyaK2szks1Wmsw%3D%3D Occurrence Handle9202571

    CAS  PubMed  Google Scholar 

  7. P Christensen S Buntzen K Krogh S Laurberg (2001) ArticleTitleIleal neoappendicostomy for antegrade colonic irrigation Br J Surg 88 1637–8 Occurrence Handle1:STN:280:DC%2BD3MnptVGmtA%3D%3D Occurrence Handle11736978

    CAS  PubMed  Google Scholar 

  8. EB Yerkes RC Rink MP Cain AJ Casale (2002) ArticleTitleUse of a Monti channel for administration of antegrade continence enemas J Urol 168 1883–5 Occurrence Handle12352382

    PubMed  Google Scholar 

  9. PR Monti RC Lara MA Dutra JR Carvalho Particlede (1997) ArticleTitleNew techniques for construction of efferent conduits based on the Mitrofanoff principle Urology 49 112–5 Occurrence Handle1:STN:280:DyaK2s7lt1Kitg%3D%3D Occurrence Handle9000197

    CAS  PubMed  Google Scholar 

  10. R Gosalbez D Wei A Gousse M Castellan A Labbie (1998) ArticleTitleRefashioned short bowel segments for the construction of catheterizable channels (the Monti procedure): early clinical experience J Urol 160 1099–102 Occurrence Handle1:STN:280:DyaK1czotlOltQ%3D%3D Occurrence Handle9719285

    CAS  PubMed  Google Scholar 

  11. CJ Vaizey E Carapeti JA Cahill MA Kamm (1999) ArticleTitleProspective comparison of faecal incontinence grading systems Gut 44 77–80 Occurrence Handle1:STN:280:DyaK1M%2FotFKmuw%3D%3D Occurrence Handle9862829 Occurrence Handle10.1136/gut.44.1.77

    Article  CAS  PubMed  Google Scholar 

  12. TH Rockwood JM Church JW Fleshman et al. (1999) ArticleTitlePatient and surgeon ranking of the severity of symptoms associated with fecal incontinence: the fecal incontinence severity index Dis Colon Rectum 42 1525–32 Occurrence Handle1:STN:280:DC%2BD3c%2FnvVKgsg%3D%3D Occurrence Handle10613469

    CAS  PubMed  Google Scholar 

  13. TH Rockwood JM Church JW Fleshman et al. (2000) ArticleTitleFecal Incontinence Quality of Life Scale: quality of life instrument for patients with fecal incontinence Dis Colon Rectum 43 9–16 Occurrence Handle1:STN:280:DC%2BD3c3ntFahtw%3D%3D Occurrence Handle10813117

    CAS  PubMed  Google Scholar 

  14. P Jess J Christiansen P Bech (2002) ArticleTitleQuality of life after anterior resection versus abdominoperineal extirpation for rectal cancer Scand J Gastroenterol 37 1201–4 Occurrence Handle1:STN:280:DC%2BD38nkvVyltg%3D%3D Occurrence Handle12408526

    CAS  PubMed  Google Scholar 

  15. MM Grumann EM Noack IA Hoffmann PM Schlag (2001) ArticleTitleComparison of quality of life in patients undergoing abdominoperineal extirpation or anterior resection for rectal cancer Ann Surg 233 149–56 Occurrence Handle1:STN:280:DC%2BD3M7ls1SnsA%3D%3D Occurrence Handle11176118

    CAS  PubMed  Google Scholar 

  16. V Violi L Roncoroni AS Boselli C Cesare ParticleDe M Livrini A Peracchia (1996) ArticleTitleContinent perineal colostomy by electrostimulated graciloplasty in abdominoperineal resection. A preliminary report Acta Biomed Ateneo Parmense 67 131–42 Occurrence Handle1:STN:280:DyaK1M7ksFOhsA%3D%3D Occurrence Handle10021696

    CAS  PubMed  Google Scholar 

  17. E Schmidt (1982) ArticleTitleThe continent colostomy World J Surg 6 805–9 Occurrence Handle1:STN:280:DyaL3s%2FpsFCqtg%3D%3D Occurrence Handle7180015

    CAS  PubMed  Google Scholar 

  18. T Sato F Konishi K Kanazawa (1997) ArticleTitleAnal sphincter reconstruction with a pudendal nerve anastomosis following abdominoperineal resection: report of a case Dis Colon Rectum 40 1497–502 Occurrence Handle1:STN:280:DyaK1c%2FmvFyrsw%3D%3D Occurrence Handle9407992

    CAS  PubMed  Google Scholar 

  19. RD Madoff CG Baeten J Christiansen et al. (2000) ArticleTitleStandards for anal sphincter replacement Dis Colon Rectum 43 135–41 Occurrence Handle1:STN:280:DC%2BD3c7lvF2mtQ%3D%3D Occurrence Handle10696884

    CAS  PubMed  Google Scholar 

  20. RD Madoff HR Rosen CG Baeten et al. (1999) ArticleTitleSafety and efficacy of dynamic muscle plasty for anal incontinence: lessons from a prospective, multicenter trial Gastroenterology 116 549–56 Occurrence Handle1:STN:280:DyaK1M7lsFaksQ%3D%3D Occurrence Handle10029613

    CAS  PubMed  Google Scholar 

  21. P Rouanet P Senesse D Bouamrirene et al. (1999) ArticleTitleAnal sphincter reconstruction by dynamic graciloplasty after abdominoperineal resection for cancer Dis Colon Rectum 42 451–6 Occurrence Handle1:STN:280:DyaK1M3ivFyrsA%3D%3D Occurrence Handle10215043

    CAS  PubMed  Google Scholar 

  22. E Rullier C Laurent F Zerbib JL Garrelon M Caudry J Saric (1998) ArticleTitleAnorectal reconstruction by coloperineal anastomosis and dynamic double graciloplasty after abdomino-perineal resection Ann Chir 52 905–12 Occurrence Handle1:STN:280:DyaK1M%2FpvFegsQ%3D%3D Occurrence Handle9882880

    CAS  PubMed  Google Scholar 

  23. DT Wilcox EM Kiely (1998) ArticleTitleThe Malone (antegrade colonic enema) procedure: early experience J Pediatr Surg 33 204–6 Occurrence Handle1:STN:280:DyaK1c7lvVWmsA%3D%3D Occurrence Handle9498387

    CAS  PubMed  Google Scholar 

  24. JI Curry A Osborne PS Malone (1999) ArticleTitleThe MACE procedure: experience in the United Kingdom J Pediatr Surg 34 338–40 Occurrence Handle1:STN:280:DyaK1M7mtVWrsQ%3D%3D Occurrence Handle10052818

    CAS  PubMed  Google Scholar 

  25. PI Ellsworth HW Webb JM Crump MA Barraza PS Stevens HG Mesrobian (1996) ArticleTitleThe Malone antegrade colonic enema enhances the quality of life in children undergoing urological incontinence procedures J Urol 155 1416–8 Occurrence Handle1:STN:280:DyaK283jtVajtg%3D%3D Occurrence Handle8632601

    CAS  PubMed  Google Scholar 

  26. M Goepel H Sperling M Stohrer T Otto H Rubben (1997) ArticleTitleManagement of neurogenic fecal incontinence in myelodysplastic children by a modified continent appendiceal stoma and antegrade colonic enema Urology 49 758–61 Occurrence Handle1:STN:280:DyaK2s3ptFChsw%3D%3D Occurrence Handle9145984

    CAS  PubMed  Google Scholar 

  27. P Christensen B Kvitzau K Krogh S Buntzen S Laurberg (2000) ArticleTitleNeurogenic colorectal dysfunction - use of new antegrade and retrograde colonic wash-out methods Spinal Cord 38 255–61 Occurrence Handle1:STN:280:DC%2BD3c3osVSntQ%3D%3D Occurrence Handle10822397

    CAS  PubMed  Google Scholar 

  28. K Krogh S Laurberg (1998) ArticleTitleMalone antegrade continence enema for faecal incontinence and constipation in adults Br J Surg 85 974–7 Occurrence Handle1:STN:280:DyaK1czlsFejtg%3D%3D Occurrence Handle9692576

    CAS  PubMed  Google Scholar 

  29. EW Gerharz V Vik G Webb R Leaver PJ Shah CR Woodhouse (1997) ArticleTitleThe value of the MACE (Malone antegrade colonic enema) procedure in adult patients J Am Coll Surg 185 544–7 Occurrence Handle1:STN:280:DyaK1c%2Fmslersw%3D%3D Occurrence Handle9404877

    CAS  PubMed  Google Scholar 

  30. EM Moore (1998) ArticleTitleMalone antegrade continence enema for faecal incontinence and constipation in adults Br J Surg 85 1594 Occurrence Handle1:STN:280:DyaK1M%2FjvFGgsg%3D%3D Occurrence Handle9823924

    CAS  PubMed  Google Scholar 

  31. AL Halverson TL Hull (2002) ArticleTitleLong-term outcome of overlapping anal sphincter repair Dis Colon Rectum 45 345–8 Occurrence Handle12068192

    PubMed  Google Scholar 

  32. PA Lehur F Zerbib M Neunlist P Glemain (2002) ArticleTitleBruley-des Varannes S. Comparison of quality of life and anorectal function after artificial sphincter implantation Dis Colon Rectum 45 508–13 Occurrence Handle12006933

    PubMed  Google Scholar 

  33. ID Sugarman PS Malone TR Terry MA Koyle (1998) ArticleTitleTransversely tubularized ileal segments for the Mitrofanoff or Malone antegrade colonic enema procedures: the Monti principle Br J Urol 81 253–6 Occurrence Handle1:STN:280:DyaK1c7ksleqsA%3D%3D Occurrence Handle9488068

    CAS  PubMed  Google Scholar 

  34. AC Lynch SW Beasley RW Robertson PN Morreau (1999) ArticleTitleComparison of results of laparoscopic and open antegrade continence enema procedures Pediatr Surg Int 15 343–6 Occurrence Handle1:STN:280:DyaK1Mzks1emsw%3D%3D Occurrence Handle10415282

    CAS  PubMed  Google Scholar 

  35. HF McAndrew PS Malone (2002) ArticleTitleContinent catheterizable conduits: which stoma, which conduit and which reservoir? BJU Int 89 86–9 Occurrence Handle1:STN:280:DC%2BD387hsVyjtg%3D%3D Occurrence Handle11849168

    CAS  PubMed  Google Scholar 

  36. MA Levitt SZ Soffer A Pena (1997) ArticleTitleContinent appendicostomy in the bowel management of fecally incontinent children J Pediatr Surg 32 1630–3 Occurrence Handle1:STN:280:DyaK1c%2Flslahuw%3D%3D Occurrence Handle9396543

    CAS  PubMed  Google Scholar 

  37. J Ganck ParticleDe K Everaert E Laecke ParticleVan W Oosterlinck P Hoebeke (2002) ArticleTitleA high easy-to-treat complication rate is the price for a continent stoma BJU Int 90 240–3 Occurrence Handle12133058

    PubMed  Google Scholar 

  38. K Bujko MP Nowacki J Oledzki R Sopylo J Skoczylas M Chwalinski (2001) ArticleTitleSphincter preservation after short-term preoperative radiotherapy for low rectal cancer–presentation of own data and a literature review Acta Oncol 40 593–601 Occurrence Handle1:STN:280:DC%2BD3Mrms1eqtw%3D%3D Occurrence Handle11669331

    CAS  PubMed  Google Scholar 

  39. D Shibata JG Guillem N Lanouette et al. (2000) ArticleTitleFunctional and quality-of-life outcomes in patients with rectal cancer after combined modality therapy, intraoperative radiation therapy, and sphincter preservation Dis Colon Rectum 43 752–8 Occurrence Handle1:STN:280:DC%2BD3czhsFKjtw%3D%3D Occurrence Handle10859073

    CAS  PubMed  Google Scholar 

  40. J Engel J Kerr A Schlesinger-Raab R Eckel H Sauer D Holzel (2003) ArticleTitleQuality of life in rectal cancer patients: a four-year prospective study Ann Surg 238 203–13 Occurrence Handle12894013

    PubMed  Google Scholar 

  41. J Kerr J Engel D Holzel (2002) ArticleTitleColostomies may influence patient quality of life more than poor sphincter function J Clin Oncol 20 3930–1 Occurrence Handle12228215

    PubMed  Google Scholar 

  42. BD Minsky (2002) ArticleTitleSphincter preservation for rectal cancer: fact or fiction? J Clin Oncol 20 1971–2 Occurrence Handle11956254

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Digestive Surgery, Faculty of Medicine, , University of Paul Sabatier,, Toulouse,, France

    Guillaume Portier M.D., Nicolas Bonhomme M.D., Ivan Platonoff M.D. & Frank Lazorthes M.D.

Authors
  1. Guillaume Portier M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nicolas Bonhomme M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ivan Platonoff M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Frank Lazorthes M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

About this article

Cite this article

Portier, G., Bonhomme, N., Platonoff, I. et al. Use of Malone Antegrade Continence Enema in Patients With Perineal Colostomy After Rectal Resection . Dis Colon Rectum 48, 499–503 (2005). https://doi.org/10.1007/s10350-004-0802-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10350-004-0802-x

Keywords

Search

Navigation