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Single institution review of Mini-ACE® low-profile appendicostomy button for antegrade continence enema administration

  • Joseph J. Lopez
    Correspondence
    Corresponding author at: Comprehensive Colorectal Center- Children's Mercy Kansas City, 2401 Gilham Road, Kansas City, MO 64108, USA.
    Affiliations
    Comprehensive Colorectal Center - Children's Mercy Hospital/Kansas City, Kansas City, MO 64108, USA

    Department of Pediatric Surgery – Children's Mercy Hospital/University of Missouri Kansas City, Kansas City, MO 64108, USA
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  • Wendy J. Svetanoff
    Affiliations
    Department of Pediatric Surgery – Children's Mercy Hospital/University of Missouri Kansas City, Kansas City, MO 64108, USA
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  • Nicholas Bruns
    Affiliations
    Comprehensive Colorectal Center - Children's Mercy Hospital/Kansas City, Kansas City, MO 64108, USA

    Department of Pediatric Surgery – Children's Mercy Hospital/University of Missouri Kansas City, Kansas City, MO 64108, USA
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  • Wendy E. Lewis
    Affiliations
    Comprehensive Colorectal Center - Children's Mercy Hospital/Kansas City, Kansas City, MO 64108, USA

    Department of Pediatric Surgery – Children's Mercy Hospital/University of Missouri Kansas City, Kansas City, MO 64108, USA
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  • Christine N. Warner
    Affiliations
    Comprehensive Colorectal Center - Children's Mercy Hospital/Kansas City, Kansas City, MO 64108, USA

    Department of Pediatric Surgery – Children's Mercy Hospital/University of Missouri Kansas City, Kansas City, MO 64108, USA
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  • James A. Fraser
    Affiliations
    Department of Pediatric Surgery – Children's Mercy Hospital/University of Missouri Kansas City, Kansas City, MO 64108, USA
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  • Kayla B. Briggs
    Affiliations
    Comprehensive Colorectal Center - Children's Mercy Hospital/Kansas City, Kansas City, MO 64108, USA

    Department of Pediatric Surgery – Children's Mercy Hospital/University of Missouri Kansas City, Kansas City, MO 64108, USA
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  • Alonso Carrasco
    Affiliations
    Comprehensive Colorectal Center - Children's Mercy Hospital/Kansas City, Kansas City, MO 64108, USA

    Department of Pediatric Urology - Children's Mercy Hospital/University of Missouri Kansas City, Kansas City, MO 64108, USA
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  • John M. Gatti
    Affiliations
    Comprehensive Colorectal Center - Children's Mercy Hospital/Kansas City, Kansas City, MO 64108, USA

    Department of Pediatric Urology - Children's Mercy Hospital/University of Missouri Kansas City, Kansas City, MO 64108, USA
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  • John M. Rosen
    Affiliations
    Comprehensive Colorectal Center - Children's Mercy Hospital/Kansas City, Kansas City, MO 64108, USA

    Department of Pediatric Gastroenterology - Children's Mercy Hospital/University of Missouri Kansas City, Kansas City, MO 64108, USA
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  • Rebecca M. Rentea
    Affiliations
    Comprehensive Colorectal Center - Children's Mercy Hospital/Kansas City, Kansas City, MO 64108, USA

    Department of Pediatric Surgery – Children's Mercy Hospital/University of Missouri Kansas City, Kansas City, MO 64108, USA
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Published:December 24, 2021DOI:https://doi.org/10.1016/j.jpedsurg.2021.12.016

      Abstract

      Purpose

      Malone antegrade continence enemas (MACE) provide a conduit in which the patient can achieve improved continence, be clean of stool, and gain independence in maintaining bowel function. The Mini-ACE® is a low-profile balloon button that is used to facilitate the administration of antegrade enemas. We sought to describe our practice and short-term outcomes.

      Methods

      This work is a retrospective review of the Mini-ACE® appendicostomy button from April 2019 to March 2021, with follow-up concluding in October 2021. Patient demographics, colorectal diagnoses, and outcomes were examined.

      Results

      Forty-three patients underwent Mini-ACE® placement; 22 (51%) were male. The average age at Mini-ACE® insertion was 9.2 years (range 3–20 years). The most common diagnoses were functional constipation in 19 (44%), anorectal malformation in 15 (35%), and Hirschsprung disease in 3 (7%), spinal differences 3 (7%). There were no intra-operative complications, but 5 (12%) required prolapse resection. The median length of stay was two days (IQR 1, 4). Patients achieved self-catheterization at 4.5 [3,7] months from MACE creation, with 38 children (88%) reporting excellent success in remaining clean of stool.

      Conclusion

      The Mini-ACE® appears to be a safe and low-profile option for antegrade continence enema access. Further research is needed directly comparing complications and patient satisfaction rates between different MACE devices and overall quality of life.

      Level of evidence

      Level IV.

      Keywords

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