Appendicostomy (Malone Procedure)
Appendicostomies are an option for fecal incontinence patients who have established success in attaining an artificial way to keep them clean and in normal underwear through the bowel management program and who have reached an appropriate age (old enough and responsible enough to take on some of their own medical care and do it themselves).
Most preschool and school-age children enjoy a good quality of life while undergoing the bowel management program. However, when they get older, many express a high degree of dissatisfaction. They feel that their parents are intruding on their privacy by giving them enemas. It is feasible but rather difficult for patients to administer the enema themselves. For this specific group of children, as well as for adults, an operation called a continent appendicostomy has been designed.
Appendicostomy illustration: The appendix is connected to the belly button so a tube can be passed through it for the enema administration.
It is important to stress that the Malone procedure is just another way to administer an enema and therefore, before performing the operation, the child has to be perfectly clean with a bowel management regimen.
The operation consists of connecting the appendix to the umbilicus, and creating a valve mechanism that allows catheterization of the appendix for the enema fluid, but avoids leakage of stool through it. The operation involves a small incision below the belly button and sometimes can be done with the help of laparoscopy to minimize the incision. It takes approximately two hours to complete. We prefer the use of the appendix rather than an artificial device because it is cosmetically more hidden, and it avoids problems with the device caused by irritation of the surrounding skin.
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