A Malone stoma, also known as a Malone Antegrade Continence Enema (MACE) stoma, is a surgically created channel. It connects the large intestine to the skin surface, providing a direct route for administering enema solutions. This enables controlled bowel emptying.
Purpose and Candidates for the Procedure
The Malone stoma is primarily created to manage chronic fecal incontinence or severe constipation when conservative methods, such as dietary changes, bowel training, or oral medications, have proven insufficient. Individuals who benefit from this surgery have underlying medical conditions. These conditions include spina bifida, anorectal malformations, Hirschsprung’s disease, and certain spinal cord injuries. The procedure aims to provide a reliable method for bowel management, improving quality of life and independence.
The Surgical Creation
The surgical procedure for creating a Malone stoma involves using a small piece of the appendix. This segment is brought to the skin surface. Surgeons place the stoma within the navel or on the lower right side of the abdomen. A one-way valve is incorporated into the channel, which helps prevent stool or bodily fluids from leaking out. The procedure can be performed using either a laparoscopic approach, involving small incisions and a camera, or through a traditional open surgery, with laparoscopic methods leading to quicker recovery times.
Daily Management and Enema Administration
Daily management of a Malone stoma involves administering an enema, often referred to as a “flush” or “washout.” A thin, flexible catheter is inserted into the stoma, through which the enema solution is infused directly into the colon. This solution travels through the large intestine, helping to loosen and flush out stool. The individual sits on a toilet during this process, and a bowel movement can be expected within 10 to 20 minutes after the solution has been administered.
A consistent daily routine is important for effective bowel management, though some individuals may perform flushes every other day. Common enema solutions include saline or warm tap water, but a doctor may prescribe other additives, such as phosphate enema. After the initial surgery, a temporary tube is left in place for several weeks to allow the channel to heal, then a permanent catheterization routine begins.
Potential Complications and Solutions
Some complications can arise following a Malone stoma procedure. Stomal stenosis, a narrowing of the stoma opening, occurs in 11-36% of patients. This narrowing can make catheter insertion difficult or painful and may require regular dilation with a catheter or surgical revision to widen the opening. Leakage from the stoma is another issue, with rates up to 40%.
Granulation tissue, which appears as small, red, bumpy growths around the stoma site, may also develop. While sometimes not affecting the function of the stoma, excessive granulation tissue may require local treatment or removal. Other less common issues include stomal infection, pain during catheterization, or channel obliteration. Many of these complications have established management strategies, ranging from conservative measures like dressings or antibiotics to minor surgical interventions.