The Antegrade Colonic Enema (ACE) surgery, also referred to as an Appendicostomy or MACE procedure, involves using a part of your appendix to create a passageway from your abdomen to your colon (large intestine). You or your child’s life may be affected by severe constipation or fecal incontinence. This method helps in the regulation of bowel motions and helps flush the colon.

If you have problems going to the bathroom (pooping), you might be a good candidate for this procedure. Some medical conditions make it difficult to control your bowel movements. These may be congenital problems affecting your colon, rectum, or anus. If you suffer from nerve disorders (neuropathies) that cause messages to be sent to your anus, the ACE surgery may also be beneficial.

Reason for undergoing the procedure

When all other methods of controlling bowel movements have failed, you can benefit from an ACE surgery. Prior to considering the ACE surgery for either adults or children, healthcare providers could recommend the following:

  • Bowel training or biofeedback.
  • Dietary changes.
  • Medications such as bowel stimulants.
  • Supplements such as fiber supplements.

The ACE surgery can be used on both adults and children. You might not be able to control when you pass stool or be unable to pass stool at all. If you have a history of any of the following, you or your child might benefit from the MACE procedure.

  • Anorectal malformation.
  • Fecal incontinence.
  • Hirschsprung disease.
  • Severe constipation.
  • Spina bifida.


Bowel function problems may not always be resolved with ACE surgery. It’s still possible for you or your child to have constipation or fecal incontinence. Additional problems consist of:

  • Fluid or feces leaking from your anus.
  • The stoma becomes narrower.

Before the procedure

To prepare you for the ACE surgery, the healthcare provider will instruct you to do the following:

  • When you should stop eating or drinking before the ACE surgery.
  • Tell the healthcare provider if you or your child is taking any medication, they will instruct you if you or your child could take the medication.

During the procedure

Your healthcare provider creates a small hole (stoma) in the abdomen during the ACE surgery. Usually, this occurs on the right side of your abdomen or in your belly button. Surgeons performing the surgery will do the following:

  • Use a little portion of your intestine or appendix to create a tube.
  • Insert the tube into the large intestine.
  • Attach the tube to your abdomen’s stoma.
  • They insert a catheter to maintain the stoma open.

An ACE surgery is usually performed through laparoscopic surgery by healthcare providers. The process may need two hours or more.

After the procedure

You will learn how to use a catheter inserted into your stoma to flush liquids from your healthcare team. Individuals are often sent home the same or next day.


An ACE surgery can help manage bowel movements, allowing you or your child to go without soiling diapers for extended periods. During this procedure, the bowels are flushed using an enema, ensuring privacy as the stoma remains discreet. Most activities, including sports, can still be enjoyed.

After ACE surgery, the stoma is typically maintained for about a month. Patients are advised to avoid strenuous lifting and sports for four to six weeks post-surgery. After this period, the ACE tube may be removed, leaving access for flushing only when needed with a tube.

It’s crucial to seek medical attention if experiencing these symptoms:

  • Bloated abdomen
  • Fever
  • Nausea and vomiting
  • Pain at the surgery site or during flushing
  • Redness or swelling at the surgery site