Single institution review of Mini-ACE® low-profile appendicostomy button for antegrade continence enema administration

Purpose: Malone antegrade continence enemas (MACE) provide a conduit in which the patient can achieve improved continence, be clean of stool, and gain independence in maintaining bowel function. The Mini-ACE (R) is a low-profile balloon button that is used to facilitate the administration of antegrade enemas. We sought to describe our practice and short-term outcomes. Methods: This work is a retrospective review of the Mini-ACE (R) appendicostomy button from April 2019 to March 2021, with follow-up concluding in October 2021. Patient demographics, colorectal diagnoses, and outcomes were examined. Results: Forty-three patients underwent Mini-ACE (R) placement; 22 (51%) were male. The average age at Mini-ACE (R) insertion was 9.2 years (range 3-20 years). The most common diagnoses were functional constipation in 19 (4 4%), anorectal malformation in 15 (35%), and Hirschsprung disease in 3 (7%), spinal differences 3 (7%). There were no intra-operative complications, but 5 (12%) required prolapse resection. The median length of stay was two days (IQR 1, 4). Patients achieved self-catheterization at 4.5 [3,7] months from MACE creation, with 38 children (88%) reporting excellent success in remaining clean of stool. Conclusion: The Mini-ACE (R) appears to be a safe and low-profile option for antegrade continence en-ema access. Further research is needed directly comparing complications and patient satisfaction rates between different MACE devices and overall quality of life. Level of evidence: Level IV. (c) 2021 Published by Elsevier Inc.