The initial operations sutured the appendix to the abdominal wall such that a catheter could be inserted through the appendix and into the cecum, when desired to flush in the enema solution. This procedure is called the Malone antegrade continence enema, or ACE technique. Although highly successful in correcting fecal incontinence and chronic constipation, many patients found it difficult or painful to insert the catheter, or that fecal material occasionally leaked, or that inflammation developed around the appendix opening on the skin. It has also been found advisable to save the appendix for drainage of the bladder when necessary for patients with neurologic disorders. During the past 4 years, we have found that placing a small intravenous catheter into the cecum and then bringing it out through the skin a few inches away, provides a very simple and safe method of performing the ACE procedure.
Patients are able to participate in almost all types of vigorous sports.
The operation rarely takes more than 1 hour. Most patients will be discharged home within 2 days. Infection around the catheter occurs in less than 10 percent. An occasional catheter has been inadvertently dislodged weeks or months later in which case it is often possible to insert a guide wire, remove the catheter, and insert a new catheter over the guide wire. More severe complications, such as peritonitis, or bleeding are extremely uncommon.