Appendicostomy (MACE Procedure)

Severe constipation or fecal incontinence can disrupt life for you or your child. Appendicostomy, or MACE procedure, is surgery to create a path from your abdomen to your colon. You use this path to flush your bowel and help control bowel movements.

Overview Procedure Details Risks / Benefits Recovery and Outlook When To Call the Doctor

Appendicostomy, or Malone appendicostomy, is a surgery to make a path between your abdomen and colon (large intestine) using a portion of your appendix. You use this path to flush your colon with liquid to remove stool (poop). Flushing with liquid (enema) helps you empty your bowel.

You may be a candidate for this procedure if you’re having trouble with bowel movements (pooping). Some health conditions cause problems with bowel movements or with controlling your bowel. These conditions may be congenital (conditions you’re born with) that affect your colon, rectum or anus. The MACE procedure can also help if you have issues with nerves (neuropathies) that send messages to your anus.

Both children and adults may have the MACE procedure. You may be unable to pass stool or be unable to control when you pass stool. You or your child may benefit from the MACE procedure if you have a history of:

  • Anorectal malformation.
  • Spina bifida.
  • Fecal incontinence.
  • Hirschsprung disease.
  • Severe constipation.

You may benefit from an appendicostomy when other ways to manage bowel movements haven’t worked. Before considering the MACE procedure in adults or children, healthcare providers may recommend:

  • Bowel training, like biofeedback.
  • Dietary changes.
  • Medications like bowel stimulants or fiber supplements.

Appendicostomy is also called a Malone antegrade colonic enema (MACE) procedure.

Follow your healthcare provider’s instructions to prepare for appendicostomy. Your provider will tell you:

  • If you can eat or drink anything before the MACE procedure.
  • What time you should stop eating and drinking before the procedure.

Your provider will give you instructions on how to clear your bowel before surgery. If you or your child take any medications, ask your provider if you should take them before the procedure.

During the MACE procedure, your healthcare provider makes a small opening (stoma) in the skin of your abdomen (belly). This is usually in your belly button or on the right side of your belly. During the procedure, surgeons:

  • Use a small piece of your appendix or intestine to form a tube.
  • Place the tube inside your large intestine.
  • Connect the tube to the stoma in your belly.
  • Place a catheter in the stoma to keep it open.

Healthcare providers typically use laparoscopic surgery to perform an appendicostomy. The procedure can take about two hours.

Your care team shows you how to flush your bowel with liquid through a catheter placed in the stoma. People are usually discharged home the same day or the next day.

Appendicostomy can help you or your child control bowel movements with the goal of having clean periods of time without soiling. You control these movements by performing an enema to flush your bowel. Other people can’t see the stoma, so you can maintain your privacy. You can also play sports and take part in most activities.

Appendicostomy may not fix all problems with bowel function. You or your child may still experience constipation or fecal incontinence. Other complications include:

  • Leaking of stool or fluid from your anus.
  • Narrowing of the appendicostomy.

The appendicostomy stays in place for about one month after the MACE bowel procedure. Most people are asked to refrain from heavy lifting and sports for four to six weeks after surgery.

After about a month, your healthcare provider may remove the appendicostomy tube so it can be accessed with a tube only when you need to flush it.

Talk to your healthcare provider about when you can resume normal activities and return to work or school.

When should I call my healthcare provider after an appendicostomy?

Talk to your healthcare provider if you or your child has:

  • Bloated abdomen.
  • Fever.
  • Nausea and vomiting.
  • Pain at the surgery site or during flushing.
  • Redness or swelling at the surgery site.

What should I do if I have trouble with bowel flushing?

Talk to your healthcare provider if you have difficulty placing the tube in the stoma to flush your bowel. Tell your provider if you or your child experience:

  • Leaking from the stoma after you remove the tube.
  • Bowel incontinence between flushes.
  • Diaz S, Bittar K, Mendez MD. Constipation (https://www.ncbi.nlm.nih.gov/books/NBK513291/). [Updated 2023 Jan 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Accessed 12/5/2023.
  • Grabski DF, Hu Y, Rasmussen SK, McGahren ED, Gander JW. Laparoscopic Appendicostomy Low-Profile Balloon Button for Antegrade Enemas in Children (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7364318/). J Laparoendosc Adv Surg Tech A. 2018 Mar;28(3):354-358. Accessed 12/5/2023.
  • Hooker E, Martin B, Gee O, Jester I. Antegrade continence enema stoppers: a pilot study on patient preferences (https://pubmed.ncbi.nlm.nih.gov/35980916/). Br J Nurs. 2022 Aug 11;31(15):770-774. Accessed 12/5/2023.
  • Spinelli M, Sampogna G, Rizzato L, Spinelli A, Sammartano F, Cimbanassi S, et al. The Malone antegrade continence enema adapting a transanal irrigation system in patients with neurogenic bowel dysfunction (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8065210/). Spinal Cord Ser Cases. 2021 Apr 23;7(1):34. Accessed 12/5/2023.

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