Malone appendicostomy in a Patient with Prior Abdominal Surgery via a prior abdominal incision

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 for the application.

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, particularly in patients with anorectal malformations, Hirschsprung disease, medically refractory constipation, or spinal disorders.

Approximately 5 centimeters of appendix is left for the imbrication and to reach the umbilicus without tension.

The imbrication acts as a valve mechanism to prevent reflux through the Malone.

A neo-Malone can be created if no appendix is available or if a Mitrofanoff is being done at the same time.

The technique spares the infraumbilical fascia by entering the abdomen through the umbilical ring with a mosquito clamp.

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 the institution from 2020 to 2021.

52 patients underwent the procedure via prior abdominal incision.

56% of patients 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 of 52 patients.

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 the open or laparoscopic group.