Laparoscopic malone procedure in pediatrics: first cases in Uruguay

Abstract

The appendicostomy procedure for performing antegrade enemas
has been published several years ago for the treatment of fecal
incontinence and constipation that are very difficult to manage. The
Malone procedure is performed in our setting, especially in patients
with fecal incontinence secondary to neurological disorders such as
myelomeningocele using a conventional approach. Other indications
of it is severe constipation, in which pharmacological measures
have been exhausted and the only effective treatment is enemas.
The main objective of the procedure is to offer children and their
families an alternative when performing enemas, achieving greater
adherence to treatment and seeking to achieve a better quality of life
that allows them to adapt to the activities of their peers. On the other
hand, it allows the child to achieve a certain gradual independence
as they grow, preparing them for the future and making them active
participants in their care.
The first cases in which we use the laparoscopic approach,
its indications, the surgical technique and the initial results are
described. We think that its main advantage is the benefits of the
minimally invasive approach, such as complete exploration of the
abdominal cavity, less postoperative pain, smaller scars, and less
creation of adhesions.