From
Colorectal Channel
Malone appendicostomy in a Patient with Prior Abdominal Surgery via a prior abdominal incision
Part of
Anorectal Malformation 101 items
Chapter 1 of 6 · Fundamentals
Technique rationale
Introduction and Technique Rationale
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
A Malone appendicostomy provides an antegrade route for continent enemas as part of a bowel management plan
Laparoscopy is an ideal approach for Malone appendicostomy but requires an infraumbilical fascial incision to do the extracorporeal cecal imbrication
Prolapse of the appendiceal tissue, umbilical hernia, and stomal stenosis are described complications of Malone appendicostomy
The proposed modification spares the midline fascia, offers an opportunity to perform a scar revision, and provides abdominal access
This technique is intended for patients with a history of abdominal surgery such as a colostomy who need a mechanical regimen to empty the colon
Indications include patients with anorectal malformations, Hirschsprung disease, medically refractory constipation, or spinal disorders
The Malone will keep the patient clean after redo PSARP and offer the opportunity to train by holding in the flush to help develop bowel control
The abdominal incision is adequate to reach the pelvis and right lower quadrants in most cases
If the incision is not adequate, laparoscopy could be used to mobilize the right colon
The distal appendix is excised, leaving approximately 5 centimeters of appendix for the imbrication and to reach the umbilicus without tension
A neo-Malone can be created if no appendix is available or if a Mitrofanoff is being done at the same time
The imbrication acts as a valve mechanism to prevent reflux through the Malone
The umbilical technique spares the infraumbilical fascia
The catheter remains for the first month postoperatively until the patient transitions to an indwelling device or intermittent catheterizations
102 patients underwent Malone appendicostomy at our institution from 2020 to 2021
52 patients underwent the procedure by the described method using a prior abdominal incision
In the series, 56% had anorectal malformation, 23% had Hirschsprung disease, 12% had functional constipation, and 10% had a spinal disorder
48 patients had their Malone orifice placed in the umbilicus, and in 4 the right lower quadrant was used, all with a circular appendicoplasty
There were no intraoperative complications in the series
There were 2 prolapses of the Malone with umbilical hernia reported, but no significant difference compared to a group of Malone procedures done laparoscopically
There were no cases of stomal stenosis reported in either group