Stapled Neo-Malone Creation: A Simplified Technique with Comparable Outcomes for Antegrade Continence Enemas.

Abstract

Background: The Neo-Malone (neo-appendicostomy) is a modification of the antegrade continence enema (ACE) procedure that constructs a new appendix using a cecal flap from the mesenteric side of the colon. This technique is indicated in cases where the native appendix has either been previously resected or is insufficiently long for a standard Malone procedure. Recently, a linear GIA™ stapler use has been introduced to streamline and simplify the Neo-Malone creation. This study evaluates the outcomes of patients who underwent stapled Neo-Malone creation. Methods: A retrospective review of patients who underwent laparoscopic-assisted Neo-Malone creation from August 2021 to June 2024 at a single institution. Variables included demographics, surgical history, postoperative complications, and functional outcomes. Descriptive statistics were performed to analyze quantitative variables. Results: Six patients underwent stapled Neo-Malone creation at a mean age of 11 years (range 7-19). The underlying conditions included neurogenic bowel (n = 4, 67%) and cloacal malformation (n = 2, 33%). Four patients (67%) underwent concurrent ileovesicostomy or Mitrofanoff appendicovesicostomy. Complications included parastomal granulation tissue (n = 2, 33.3%), channel prolapse (n = 1, 17%), and leakage from the channel (n = 1, 17%). No stenosis or need for revision operations was reported. At a median follow-up of 14 months (IQR 12-20), all patients were clean for stool with successful Neo-Malone flushes. Conclusion: Stapled Neo-Malone creation appears to be a safe and technically simpler alternative to the traditional technique, potentially reducing operative time. The functional outcomes and rates of surgical complications are comparable to those of other ACE channel types.