Appendicostomy or Malone Procedure

While anorectal and colorectal surgeries can help repair malformations, they cannot always restore the nerves and muscles that the body relies on to tell a child when it’s time to go to the bathroom.  Some children who have surgery for anorectal malformations, Hirschsprung disease, or congenital damage to the nerves that control the bowels will have some degree of fecal incontinence. The vast majority have the ability to have their own bowel control. 

For children – who need a little extra help, with the aid of their parents - can also successfully be able to navigate fecal incontinence through the use of enemas and a bowel management program.  By following this program, most children are able to learn how to stay clean and wear normal underwear. As a child gets older, they often begin to want more privacy around potty time. 

An appendicostomy or Malone Procedure is an option for these older children who are able to stay clean, and are ready to take on the responsibility of managing their bowels themselves. The procedure doesn’t change the child’s regular bowel management program – it is simply another way to administer an enema that doesn’t require a parent’s help.  Most older children say that they like the independence and privacy that the procedure gives them. 

Malone Procedure Basics

For the procedure, surgeons will connect the appendix to the belly button, and create a valve that allows the appendix to be catheterized.  The valve lets the enema fluid in without allowing stool to leak out. The procedure is usually done with laparoscopic equipment (avoiding incisions) and takes about two hours to complete.  

During the operation, one end of the catheter tube is put in the appendix, and the other end of the tube is left coming out of navel. Four weeks after surgery, the tube is removed, and the child and parents are taught how to use the tube to deliver the daily enema.

Once the tube is out, the valve is completely hidden in the belly button. The valve mechanism allows the child the freedom to bathe, shower and swim without concerns. 

If the child’s appendix has already been removed, surgeons can create a special flap from the colon in a procedure called a continent neo-appendicostomy. The length of surgery and recovery time is slightly different with a continent neo-appendicostomy, but it still operates the same way as an appendicostomy.