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by Jones P

(Malone Procedure; Antegrade Colonic Enema Procedure)


What to Expect

Prior to Procedure

Your doctor will need to make sure that enemas are effective for your condition. You will also need to show good fecal control with enemas. Good control is staying clean for at least 24 hours after emptying your bowels.
You may need to stop taking some medicines up to one week before the procedure.


General anesthesia is used. You will be asleep during the procedure.

Description of the Procedure

A small cut will be made just below the bellybutton. The tip of the appendix will also be opened. The opened end will then be attached to an opening in the belly button. If the appendix has been removed previously, a new one will be created from the large intestine. A valve will then be placed at this connection. The valve allows the enema to flow in but keeps fluids from leaking out.
A tube will be passed through the belly button and valve. The tip of the tube will stay in the appendix. The end of the tube will remain outside of the bellybutton. The tube will be taped into place. This tube will stay in place for 2-4 weeks after the surgery until the area heals.

How Long Will It Take?

About 2 hours

Will It Hurt?

Anesthesia will block pain during surgery. You may have some discomfort after the surgery. You doctor will offer medication to help.

Average Hospital Stay

The length of stay may be 1-5 days. If you have any problems, you may need to stay longer.

Post-procedure Care

At the Care Center
You will be shown how to care for your tube and deliver enemas.
Enema will be given within 24 hours of the first meal. Although, you may need to wait longer if a new appendix was created.
At Home
When you return home, take these steps:
  • Follow your doctor’s instructions on cleaning the incision site. Leave the incision open to air.
  • Some leakage is normal. Try to keep area dry.
  • Avoid vigorous sports or activity until you have recovered after surgery
  • Ask your doctor about when it is safe to shower, bathe, or soak in water.
  • Once recovered there should be no activity restrictions including swimming.
  • Be sure to follow your doctor’s instructions.
Follow instruction to care for your tube. General steps include:
  • Leave the tube in place after surgery until your doctor lets you know it is okay to remove it.
  • Tape the tube in place while you heal. This will keep the tube in ideal position.
  • Follow directions to place and use the tube once you have healed.


American Society of Colon and Rectal Surgeons

American Academy of Pediatrics



Canadian Association of Gastroenterology

Sick Kids



Appendicostomy (Malone Procedure). Cincinnati Children’s Hospital website. Available at: . Accessed October 21, 2012.

Appendicostomy. Intermountain Healthcare website. Available at: . Accessed October 21, 2012.

Levitt MA, Soffer SZ, Péan A. Continent appendicostomy in the bowel management of fecally incontinent children. J Pediatr Surg . 1997 Nov;32(11):1630-3.

Taiwo A. Lawal, Shawn J. Rangel, Andrea Bischoff, Alberto Peña, and Marc A. Levitt. Journal of Laparoendoscopic & Advanced Surgical Techniques. June 2011, 21(5): 455-459.


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