Article1 min read·Published Jan 2013Older

The role of a colon resection in combination with a Malone appendicostomy as part of a bowel management program for the treatment of fecal incontinence

Part of Fecal Incontinence & Bowel Management 4 items

pubmed.ncbi.nlm.nih.gov

Michael Helmrath

Purpose: Surgical options previously described by us as part of a bowel management program for the treatment of soiling and fecal incontinence include (1) resection of a megarectosigmoid to reduce a patient's laxative requirement or (2) a Malone appendicostomy in patients who require enemas. We have found that some patients may benefit from both procedures. Methods: We reviewed 18 fecally incontinent patients with structural or functional disorders of the anorectosigmoid (16 ARM, 1 spina bifida, and 1 SCT) who underwent both procedures. Results: Of 18 patients, the enema regimen prior to resection had an average volume of 681 ml of saline (Range 400-1000 ml) and 60 ml (Range 48-117 ml) of additives (glycerine, castile soap and/or phosphate). Following the colon resection, the average volume of saline and additives was 335 ml (Range 130-650 ml) and 25 ml (Range 0-60 ml), respectively, a 50% reduction for both (P<0.01). The time for enema administration and evacuation was reduced by 25%, and the enemas were more effective, rendering the patients clean in 18 of 18 cases (follow-up was 3 months to 21 years). 2 patients later demonstrated that they could be managed with laxatives alone. Conclusion: In patients with poor continence potential and a megarectosigmoid, combining a colon resection with a Malone appendicostomy can make the enema more effective. In some rare cases we found the resection may allow for a better response to laxatives.

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Article · Jan 2013 · 1 min read

In brief

This study demonstrates that combining colon resection with Malone appendicostomy in patients with fecal incontinence and megarectosigmoid reduces enema volume and administration time by 50% and 25% respectively, while achieving complete continence in all 18 patients. The dual procedure approach is particularly effective for patients with anorectal malformations who have poor continence potential.

Written by the GCMD Library team from the article.

Michael Helmrath

Statements in this article

Surgical options for bowel management in fecal incontinence include resection of a megarectosigmoid to reduce laxative requirement or a Malone appendicostomy in patients who require enemas.
EstablishedPurpose
The study included 18 fecally incontinent patients with structural or functional disorders of the anorectosigmoid (16 anorectal malformation, 1 spina bifida, and 1 sacrococcygeal teratoma) who underwent both colon resection and Malone appendicostomy.
ResearchMethods
Prior to colon resection, the average enema regimen consisted of 681 ml of saline (range 400-1000 ml) and 60 ml (range 48-117 ml) of additives including glycerine, castile soap and/or phosphate.
ResearchResults
Following colon resection, the average enema volume was reduced to 335 ml of saline (range 130-650 ml) and 25 ml of additives (range 0-60 ml), representing a 50% reduction for both (P<0.01).
ResearchResults
The time for enema administration and evacuation was reduced by 25% following colon resection.
ResearchResults
Enemas were more effective after colon resection, rendering all 18 patients clean with follow-up ranging from 3 months to 21 years.
ResearchResults
Two patients were later able to be managed with laxatives alone following the combined procedure.
ResearchResults
In patients with poor continence potential and a megarectosigmoid, combining a colon resection with a Malone appendicostomy can make the enema more effective.
RecommendationConclusion
In rare cases, colon resection may allow for a better response to laxatives in patients with fecal incontinence.
ResearchConclusion