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

Creator(s)

Ismael Elhalaby, Children's Mercy Kansas City
Irene Isabel P. Lim, Children's Mercy Kansas CityFollow
John Gatti, Children's Mercy HospitalFollow
Joel F Koenig, Children's Mercy HospitalFollow
Elizaveta Bokova, Children's Mercy Kansas City
Wendy E. Lewis, Children's Mercy Kansas CityFollow
Christine N. Feira, Children's Mercy Kansas CityFollow
Rebecca M. Rentea, Children's Mercy HospitalFollow

Document Type

Article

Publication Date

6-2025

Identifier

DOI: 10.1089/lap.2024.0365

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.

Journal Title

Journal of laparoendoscopic & advanced surgical techniques. Part A

Volume

35

Issue

6

First Page

494

Last Page

500

MeSH Keywords

Humans; Retrospective Studies; Female; Male; Child; Laparoscopy; Enema; Adolescent; Surgical Stapling; Appendix; Young Adult; Treatment Outcome; Fecal Incontinence; Postoperative Complications

PubMed ID

40322895

Keywords

Neo-Malone appendicostomy; antegrade continence enema; bowel management; stapled Neo-Malone; stapler

Recommended Citation

Elhalaby I, Lim IIP, Gatti JM, et al. Stapled Neo-Malone Creation: A Simplified Technique with Comparable Outcomes for Antegrade Continence Enemas. J Laparoendosc Adv Surg Tech A. 2025;35(6):494-500. doi:10.1089/lap.2024.0365