Appendicostomy (MACE Procedure): Overview, Process, and Recovery

Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026

Quick Answer

Appendicostomy is a surgical procedure that manages chronic bowel dysfunction, such as severe constipation or fecal incontinence, by creating a small abdominal opening connected to the colon for regular flushing with liquid. It is typically performed laparoscopically and suits patients with conditions like spina bifida or Hirschsprung disease when other management methods have failed. [1]

What the research says

• In adults, about three in four people were still using their MACE at follow-up. A systematic review of 17 studies (404 adults, median follow-up 28.5 months) found that 75.1% continued using the Malone antegrade continence enema while 9.8% needed a colostomy. Minor stoma-related complications were most common (39.1%), followed by fecal leakage (16.2%) and stoma stenosis (11.3%), and 60% to 83% of patients reported satisfactory outcomes (PubMed: Gallo et al., Int J Colorectal Dis, 2026 [2]).

• In children, appendicostomy had more complications and revisions than tube cecostomy, with similar continence and quality of life. A systematic review of 40 studies (2,086 children) reported an overall complication rate of 16.6% for cecostomy versus 42.3% for appendicostomy. Continence and quality-of-life improvement were similar, and revision surgery was about 15% more frequent after appendicostomy (PubMed: Mohamed et al., J Pediatr Surg, 2020 [3]).

• Outcome reporting is inconsistent, so results are hard to compare. A systematic review of 48 studies of antegrade continence enema in anorectal malformation and Hirschsprung disease identified 301 different reported parameters. Most were retrospective (76%), and only 25% used patient-reported outcome measures and 6% assessed quality of life (PubMed: Olsbø et al., J Pediatr Surg, 2025 [4]).

What is an appendicostomy (MACE procedure)?

Appendicostomy, frequently referred to as the Malone antegrade colonic enema (MACE) procedure, serves as a critical surgical option for individuals experiencing severe bowel management challenges. The primary objective of this procedure is to establish a reliable and discreet access point for flushing the large intestine, thereby facilitating the regular removal of stool. This is particularly beneficial for those whose conditions are not adequately managed through dietary changes, medications, or biofeedback training. [1]

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. [1]

Indications and Candidacy

Both pediatric and adult patients may be candidates for an appendicostomy if they suffer from chronic constipation or an inability to control bowel movements. [1] Common underlying conditions that necessitate this procedure include:

Condition	Description
Spina Bifida	A congenital condition affecting spinal cord development and nerve signals to the bowel.
Hirschsprung Disease	A condition where nerve cells are missing in the colon, leading to severe blockage.
Anorectal Malformations	Congenital defects where the rectum or anus did not develop properly.
Fecal Incontinence	The inability to control bowel movements, leading to accidental soiling.
Severe Constipation	Chronic difficulty passing stool that does not respond to standard laxatives.

How is an appendicostomy performed, and how do you prepare?

Preparation for an appendicostomy involves specific instructions from a healthcare provider regarding dietary restrictions and bowel cleansing. Patients are typically required to stop eating and drinking several hours before the surgery and may need to use prescribed methods to clear the colon.

Figure 1: Illustration of the appendicostomy pathway connecting the abdominal stoma to the large intestine using the appendix.

The Surgical Process

The MACE procedure is most commonly performed using laparoscopic techniques, which involve small incisions and a camera for guidance. The surgery generally takes approximately two hours to complete. [1] During the operation, surgeons perform the following steps:

1. Stoma Creation: A small opening is made in the skin, usually within the belly button or on the right side of the abdomen. [1]

2. Tube Formation: A portion of the appendix or intestine is used to create a tube-like pathway.

3. Internal Connection: The tube is connected to the large intestine and the external stoma.

4. Catheter Placement: A temporary catheter is inserted to keep the stoma open during the initial healing phase.

What are recovery and long-term management like after an appendicostomy?

Most patients are able to return home on the same day or the day following the procedure. [1] The initial recovery period involves learning how to perform the bowel flushes correctly. The temporary tube typically remains in place for about one month before it is replaced or removed, allowing the stoma to be accessed only when needed.

Figure 2: The step-by-step process of performing an antegrade enema through an appendicostomy stoma.

Activity and Care Guidelines

Patients are generally advised to avoid heavy lifting and strenuous sports for four to six weeks post-surgery. [1] Once the stoma has healed, the procedure is discreet, and individuals can participate in most regular activities, including sports, without others noticing the stoma.

Recovery Milestone	Timeline
Hospital Discharge	Same day or next day
Initial Tube Removal	Approximately 1 month
Return to Strenuous Activity	4 to 6 weeks
Long-Term Management	Daily or scheduled flushes

What are the potential risks and complications of an appendicostomy?

An appendicostomy may not resolve all bowel problems, and possible complications include narrowing of the stoma, leaking and infection or redness at the stoma site. Some patients may still experience occasional constipation or incontinence. [1] Other potential complications include:

• Narrowing of the Stoma: The opening may become too tight, making catheter insertion difficult.

• Leaking: Fluid or stool may leak from the stoma or the anus between scheduled flushes.

• Infection or Redness: Like any surgery, there is a risk of localized irritation or infection at the stoma site.

Figure 3: Essential tips for maintaining stoma health and optimizing bowel management after a MACE procedure.

Conclusion

Appendicostomy represents a significant advancement in the management of chronic bowel disorders, providing a discreet and effective way to regain control over bowel movements. By facilitating regular flushing of the colon, the MACE procedure helps improve the quality of life for both children and adults. Patients are encouraged to consult with their surgical team to determine if this procedure is the most appropriate long-term solution for their specific needs.

Frequently Asked Questions

1. Is an appendicostomy reversible?

Yes, the procedure is reversible. Because the colon itself is not significantly altered during the surgery, its original function remains intact if the appendicostomy is no longer needed.

2. How long does the procedure take?

A typical laparoscopic appendicostomy takes about two hours to complete, though preparation and recovery time will add to the total duration of the hospital stay.

3. Where is the stoma located?

The stoma is usually placed in a discreet location, such as inside the belly button or on the right side of the abdomen, making it virtually invisible to others.

4. Can I play sports after the procedure?

Yes. After the initial recovery period of four to six weeks, most patients can return to sports and all regular activities.

5. What is the difference between appendicostomy and cecostomy?

An appendicostomy uses the appendix to create the pathway, while a cecostomy uses a tube that connects the skin directly to the cecum, the first part of the large intestine.

6. When should I call my doctor?

You should contact your healthcare provider if you experience fever, nausea, vomiting, significant pain at the surgery site, or difficulty performing the flushes.

7. Can adults have this procedure?

Yes, appendicostomy is performed on both children and adults who have severe bowel management issues.

8. What happens if I have trouble inserting the tube?

If you have difficulty placing the tube in the stoma, you should contact your healthcare provider, as the stoma may be narrowing.

9. Are there permanent tube options?

Yes, options such as the Chait tube or MiniACE are available for those who require a more permanent access solution.

10. Will I still need medication?

Some patients may still require supplemental medications or dietary adjustments to optimize their bowel management alongside the MACE procedure.

11. How do I prepare for an appendicostomy?

Your provider tells you whether you can eat or drink beforehand and when to stop, gives you instructions on how to clear your bowel before surgery, and tells you whether to take any medications before the procedure [1]. The surgery is usually laparoscopic and takes about two hours, and most people go home the same day or the next day [1]. Before discharge, the care team teaches you how to flush the bowel through the stoma catheter [1].

Related Reading

Fecal Incontinence: Symptoms, Causes, and Treatment

References

1. Cleveland Clinic. Appendicostomy (MACE Procedure): Procedure & Complications. Cleveland Clinic. Dec. 5, 2023. https://my.clevelandclinic.org/health/procedures/14372-appendicostomy-mace-procedure

2. Gallo G, De Simone V, Bellocchia AB, et al. The Malone antegrade continence enema for treating adult constipation and fecal incontinence: a systematic review of the literature. Int J Colorectal Dis. 2026;41(1):4. PMID 41483410. https://doi.org/10.1007/s00384-025-05022-5

3. Mohamed H, Wayne C, Weir A, et al. Tube cecostomy versus appendicostomy for antegrade enemas in the management of fecal incontinence in children: a systematic review. J Pediatr Surg. 2020;55(7):1196-1200. PMID 32037219. https://doi.org/10.1016/j.jpedsurg.2020.01.011

4. Olsbø S, Kiserud SG, Telle Hoel A, et al. Systematic review of reported outcomes for antegrade continence enema in patients with anorectal malformation and Hirschsprung disease. J Pediatr Surg. 2025;60(11):162634. PMID 40907881. https://doi.org/10.1016/j.jpedsurg.2025.162634

Medical Disclaimer

This article is for informational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read here.