CODE: 10.2 - Mitrofanoff-Malone operation in children with neurogenic constipation and fecal incontinence
Article published in Urologia Polska 2006/59/Suplement 1.

authors

Paweł Kroll, Andrzej Jankowski, Przemysław Mańkowski

Katedra Chirurgii Dziecięcej, Klinika Chirurgii i Traumatologii Dziecięcej AM w Poznaniu

summary

Introduction. Chronic constipation and fecal incontinence are common problems in children with neurogenic bladder. Conservative treatment is the principle of treatment in constipated children. Surgery should be considered if the conservative treatment fails. P. Malone described operation adopting Mitrofanoff principle to these children.

Objectives. To evaluate our experience in laparoscopic modification of Mitrofanoff-Malone operation in children with neurogenic constipation and fecal incontinence, and the outcome of antegrade colonic enemas (ACE).

Materials and methods. Surgical treatment was considered in children with neurogenic constipation and fecal incontinence with no improvement after the conservative treatment (dietary recommendations, mineral-base and osmotic sugar laxatives, suppositories, enemas). 23 children with neurogenic constipation and fecal incontinence. Myelodysplasia was the cause of constipation in 20 of them, in 1 sacral agenesis. In 2 cases chronic constipation and fecal incontinence were caused by imperforate anus. Children were in age 20 months to 19 years. In 8 children operation was performed in classic fashion at the time of bladder augmentation. Laparoscopic-assisted operation was performed in 15 cases. For laparoscopy we used 3 ports in 2 children, in the rest only 2 ports. First port was used for camera and insufflations, second for grasper, and the third for needleholder to suture the caecum to the abdominal wall.

Results. In all children procedure was performed without intra-operative complications. Laparoscopy enabled: precise localization, mobilization and pulling the appendix from the abdominal cavity. None of the laparoscopies required conversion to "an open surgery". All patients reached: fecal continence for 36-48 hours, regulation and control in defecation, relieve from the constipation by using antegrade colonic enemas (ACE). Complications: in 7 cases local infection of a wound occurred, in 6 children a stricture of the cutaneo-appendicoanastomosis. Mucous and fecal leakage is observed in 5 children. In 2 children appendico-cutaneostomy closed because of cessation of catheterization.

Conclusions. 1. Laparoscopy is useful in performing Mitrofanoff-Malone procedure. 2. Malone appendico-cutaneostomy with antegrade colonic enemas (ACE) improves fecal continence in children with neurogenic, chronic constipation and fecal incontinence.