Mace-Stoma By Caecal Flap Plasty
PURPOSE In patients with chronic constipation or fecal incontinence due to anorectal malformations, Hirschsprung's Disease, MMC and other causes, different techniques of ACE exist, depending on wheter there is an appendix or not. We describe our new technique of a stapeled caecal flap plasty in detail. MATERIAL AND METHODS During a 2 year period (2006-2008) 10 out of 30 patients underwent MACE-construction by stapeled caecal flap plasty. The mean age was 15 years (6.5-19.0). In 7 patients no appendix was present after earlier surgery. In 2 patients earlier appendicocaecostomies showed stenosis and in 1 patient the appendix was obliterated. All patients underwent stapeled caecal flap plasty and intraabdominal antirefluxive fixation. In 7 patients the ACE was fixed in the right midabdomen and in 3 in the umbilicus. RESULTS During the follow-up period 5 patients showed no problems at all. 2 had initial problems in catheterization of the MACE, 1 showed stenosis of the MACE, requiring surgical dilatation. 2 patients still show problems in the self-organisation of catheterization with delayed defecation while the stoma works well. CONCLUSIONS Our new technique of stapeled caecal flap plasty is a good alternative procedure to construct a continent catheterizable ACE-stoma in patients without appendix.