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RISK ANALYSIS OF THE PROGNOSTIC FACTORS FOR THE DEVELOPMENT OF
STOMAL STENOSIS WITH THE MACE PROCEDURE
Paul AUSTIN, Adam RENSING and Joel KOENIG
Washington University in St. Louis School of Medicine, Urology, Saint Louis, USA
PURPOSE
We hypothesize that stomal stenosis (SS) is associated with the type of efferent limb used for MACE construction. We
performed a risk analysis and evaluated factors associated with the development of cecostomy SS.
MATERIAL AND METHODS
We reviewed 43 consecutive patients undergoing a MACE procedure by a single surgeon. Data collection included the
type of channel construction, stoma site, preoperative Z-score BMI, pre-operative diagnosis and development of SS. We
defined SS as those requiring surgical revision, Chait tube placement or clinical documentation of inability to catheterize.
We performed an Odds Ratio (OR) analysis to evaluate the association with the development of SS.
RESULTS
SS developed in 21 patients (49%) with an average follow-up of 4.2 years. The majority of patients had a diagnosis of
myelomenigocele (84%) and there was no significant difference in gender distribution (51% males:49% females).
Nearly one third of the patients (28%) were obese (BMI ≥ 95th percentile). The distribution types of MACE efferent
limbs consisted of 53% appendicocecostomy, 42% cecal-wall flap and 5% ileocecostomy. The OR analysis revealed that
obesity was the only variable that was associated with SS (OR 4.8 95% CI, p=0.05).
CONCLUSIONS
The type of efferent limb or the selection of stoma site did not contribute to the SS rate. The only statistically significant
factor associated with SS was the patient’s age and sex-adjusted BMI. Obesity is associated with a higher risk for SS in
MACE channels.