The Malone antegrade continence enema for treating adult constipation and fecal incontinence: a systematic review of the literature
Gaetano Gallo, Veronica De Simone, Alex Bruno Bellocchia, Salvatore Sorrenti, Alberto Realis Luc, Giuseppe Clerico, Roberto Sorge, Pierpaolo Sileri, Mario Trompetto, Gianpiero Gravante

TL;DR
The Malone antegrade continence enema (MACE) is a safe and effective treatment for adults with chronic constipation or fecal incontinence, offering an alternative to permanent colostomy.
Contribution
This systematic review evaluates MACE's efficacy and safety in adults, highlighting its potential as a reversible alternative to colostomy.
Findings
75.1% of patients continued using MACE at final follow-up.
Minor stoma-related complications were the most frequent issue.
60%–83% of patients reported satisfactory outcomes and improved quality of life.
Abstract
The Malone antegrade continence enema (MACE) offers a minimally invasive and potentially reversible option for managing chronic constipation and fecal incontinence (FI). This systematic review evaluates its efficacy, safety, and long-term outcomes in adults. A comprehensive search was conducted across PubMed, EMBASE, and CENTRAL databases up to April 2025 to identify studies on MACE in adults. Study quality was assessed using the Newcastle–Ottawa scale. The primary outcome was the proportion of patients continuing MACE at follow-up (treatment success); failure was defined as conversion to definitive colostomy. Seventeen studies with 404 patients were included. Study quality was rated moderate to good. The most common indications were neurological disorders (25.8%), prior surgeries (16.8%), idiopathic constipation (14.2%), and traumatic spinal injuries (11.6%). Techniques included…
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Taxonomy
TopicsPelvic floor disorders treatments · Gastrointestinal motility and disorders · Congenital gastrointestinal and neural anomalies
