Quality of life in pediatric patients with unremitting constipation pre and post Malone Antegrade Continence Enema (MACE) procedure

• Published in: Journal of pediatric surgery 2013-08, Vol.48 (8), p.1733-1737
• Main Authors: Har, Aileen F, Rescorla, Frederick J, Croffie, Joseph M
• Format: Article
• Language: English
• Subjects: Adolescent; Biofeedback, Psychology; Cecostomy - psychology; Child; Child, Preschool; Chronic Disease; Combined Modality Therapy; Constipation - psychology; Constipation - surgery; Constipation - therapy; Encopresis - psychology; Encopresis - surgery; Encopresis - therapy; Enema - methods; Fecal Impaction - prevention & control; Fecal Incontinence - psychology; Fecal Incontinence - surgery; Fecal Incontinence - therapy; Female; Functional constipation; Humans; Laxatives - therapeutic use; Male; Malone antegrade continence enema; Pediatrics; Postoperative Complications - etiology; Postoperative Complications - psychology; Quality of Life; Surgery; Surgical Stomas
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2013.01.045

Abstract Objective The primary aim of this study was to determine if there is a change in the quality of life in pediatric patients with unremitting functional constipation and/or encopresis after undergoing a MACE procedure. Methods Patients, ages 5 to 18 years with unremitting constipation and a normal evaluation, including anorectal manometry and colonic manometry, who opted to undergo a MACE procedure were contacted to participate in the study. Patients with congenital anorectal malformations as well as spinal cord disorders were excluded from the study. The patient's parent/guardian completed the PedsQLTM Generic Core Scales QOL survey prior to the operation, 6 months, and 12 months after the procedure. Results A total of 15 consecutive patients meeting protocol criteria were recruited within a period of 20 months. The mean age at the MACE procedure was 9.8 years (range 7.0–11.1). 5 patients were female. The mean QOL score pre-MACE was 64.1. At 6 months post-MACE the mean overall QOL score was 90.2, and it was 92.0 at 12 months. All 15 patients at the 6 month follow up had significant improvement in their QOL (p = 1.9 × 10 − 7 ) and all subcategories of QOL were significantly improved as well. Conclusions A MACE procedure is of benefit to otherwise normal pediatric patients who have unremitting functional constipation with failure of medical treatment. Our patients had a significant improvement in all QOL categories and overall QOL.