Abstract Book - 26th ESPU Congress, Joint Meeting with ICCS + SPU + AAP/SOU + AAPU + SFU

15:48 - 15:54

ICCS S6-4

(LO)

PREDICTING STOMAL COMPLICATIONS IN PEDIATRIC MALONE ANTEGRADE

CONTINENCE ENEMA (MACE) PATIENTS

Sami SAIKALY

, Mark RICH

and Hubert SWANA

1) University of Central Florida School of Medicine, School of Medicine, Orlando, USA - 2) Nemours Children's Hospital,

Pediatric Urology, Orlando, USA

PURPOSE

When conservative treatments for chronic constipation fail, the Malone antegrade continence enema (MACE) is an

effective alternative surgical option. This study aims to identify surgical risk factors for complications of the MACE

procedure in children.

MATERIAL AND METHODS

We retrospectively reviewed patient charts from 97 pediatric MACE patients at four hospitals. Data collected included:

age, weight status ( obese vs non-obese), open vs. laparoscopic surgery, stomal location, use of a permanent stomal

button. Complications including stomal stenosis, leakage, and infection were analyzed. Two groups were compared. One

group had a permanent Mic-key button placed across the repair. The other group did not. 72 of 74 surgeries without

button use utilized traditional imbrication sutures. None of the 23 surgeries involving button use did.

RESULTS

Twenty two patients (23.7%) developed stomal stenosis and twenty seven patients (27.8%) experienced stomal

leakage. The placement of a stomal button resulted in: 24.8% greater chance of complication (p=.026); 31.9%

greater rate of stomal leakage (p=.003); 16% greater rate of stomal site infection (p=.011) and a 25.4% lower rate of

stomal stenosis (p=.012). In patients without button placement, 32.35% of patients with umbilical stomas experienced

stomal leakage, versus 9.09% of patients with RLQ stomas (p=.019).

CONCLUSIONS

The use of a permanent stomal button across a MACE repair decreases the risk of stomal stenosis but significantly

increases the risk of fecal leakage and infection. The use of imbrication sutures may reduce these risks. While an

umbilical stoma is more cosmetically appealing, it is associated with an increased risk of stool leakage.