Long-term results of Malone's procedure with antegrade irrigation for severe chronic constipation [Efficacité à long terme de la technique de Malone avec irrigation antérograde pour constipation chronique]

摘要

Aim: The Malone antegrade colonic enema (MACE) procedure is a minimally invasive treatment for severe constipation, and the objective of the present study was to assess the long-term results and quality of life in patients undergoing such colonic irrigation. Method: Twenty-five adult patients underwent MACE between 1995 and 2002 for chronic constipation. After a mean follow-up duration of 55 ± 36 months, the patients answered questionnaires to assess stoma usage, constipation score (KESS) and quality of life (GIQLI). Results: The mean quality-of-life scores for these patients was 83 ± 28 (normal: 125), while their mean constipation score was 19 ± 9 (normal: < 7). Twelve patients stopped the irrigations, and eight underwent further surgical procedures, specifically, total colectomy with ileostomy (n=2), ileorectal anastomosis (n=3) or segmental colectomy (n=3). Finally, five patients had permanent stoma. The 13 remaining patients continued to perform irrigations (4.6 per week). The patients' mean KESS score was 18.3 ± 8 (normal: < 7), and the mean GIQLI score was 98 ± 20 (normal: 125). Continence status had no influence on success. Conclusion: In our series, MACE was successful in half the patients who were, thus, able to avoid more aggressive approaches. However, when MACE failed, other surgical procedures were often required.