| Malone antegrade continence enema | |
|---|---|
 The vermiform appendix is typically used in the Malone antegrade continence enema. | |
| Other names | MACE, Malone procedure, ACE procedure, continent appendicostomy, Malone antegrade colonic enema |
A Malone antegrade continence enema is a surgical procedure used to create a continent pathway proximal to the anus that facilitates fecal evacuation using enemas.
The operation involves connecting the appendix to the abdominal wall and fashioning a valve mechanism that allows catheterization of the appendix, but avoids leakage of stool through it. If the appendix was previously removed or is unusable, a neoappendix can be created with a cecal flap.[1]
It is done to treat fecal incontinence unresponsive to treatment with medications. It is frequently done with a procedure (Mitrofanoff procedure) to treat urinary incontinence as the two often co-exist,[2] such as in spina bifida.
A percutaneous cecostomy tube (C-tube)[3] is an alternative to a MACE. It involves the surgical insertion of a catheter into the cecum for the same goal (of performing enemas). Percutaneous cecostomy procedures, like MACEs, have been performed laparoscopically.[citation needed]
The procedure is named after the surgeon Padraig Malone who helped popularized it in the 1990s and described it with co-authors as the antegrade continence enema procedure.[4]