MACE vs Cecostomy
MACE vs Cecostomy: Understanding the Two Main ACE Approaches
MACE and cecostomy are two ways of creating access for an antegrade continence enema (ACE). The goal of the irrigation approach is similar, but the route into the bowel is different. Understanding that distinction also makes it easier to see where a low-profile device such as the AMT MiniACE® Button fits in.
They use the same basic idea, but not the same access route.
ACE describes the direction and method of bowel irrigation: fluid is introduced into the colon through an access point higher up in the bowel rather than through the rectum.
MACE usually refers to the Malone antegrade continence enema procedure, in which the appendix is used to create a catheterisable channel to the colon. The resulting channel is commonly called an appendicostomy.
Cecostomy provides access directly into the caecum, typically through a tube or button placed through the abdominal wall.
ACE describes the irrigation approach. MACE and cecostomy describe how access to the bowel is created.
What does “antegrade” actually mean?
The word antegrade describes movement in the forward direction through the colon. In an ACE approach, irrigation enters through an abdominal access point and travels into the colon from the proximal side.
This is different from retrograde irrigation, where fluid is introduced through the rectum and travels upward through the colon.
MACE and cecostomy: what actually changes?
An appendix-based channel
In a traditional Malone procedure, the appendix is used to create a catheterisable channel between the abdominal wall and the caecum. This channel allows intermittent access for antegrade irrigation.
The term “MACE” refers to the procedure; “appendicostomy” describes the appendix-based access channel created by that procedure.
Direct access to the caecum
A cecostomy creates access directly into the caecum through the abdominal wall. A tube or low-profile button can provide the access point used for antegrade irrigation.
The exact technique and device used depend on the clinical setting and the individual procedure.
MACE vs cecostomy
| Feature | MACE / appendicostomy | Cecostomy |
|---|---|---|
| What is it? | An antegrade continence enema procedure using an appendix-based catheterisable channel. | Access created directly into the caecum for antegrade irrigation. |
| Where is access created? | Through an appendix-based channel leading to the caecum. | Directly into the caecum. |
| How is irrigation delivered? | Through the catheterisable channel. | Through the cecostomy tube or button. |
| Is it an ACE approach? | Yes. | Yes. |
ACE is the approach. MACE and cecostomy describe access.
These terms are sometimes used interchangeably in everyday conversation, but they describe different parts of the picture.
Think of ACE as the overall irrigation concept. Within that concept, there can be different ways to create the route into the bowel.
Where does the AMT MiniACE® Button fit into this?
The AMT MiniACE® Button is a low-profile device designed for antegrade continence enema access. AMT states that the MiniACE® Button is cleared for both appendicostomy and cecostomy.
That means the device itself does not define whether the underlying access is a MACE/appendicostomy or a cecostomy. The surgical or procedural route determines the access; the button provides the low-profile access point for the irrigation system.
AMT MiniACE® Button Enema — Low Profile
Available through Medisa in 10Fr, 12Fr and 14Fr options, with different stoma length configurations.
The access point is small, but its design is important.
A low-profile button sits closer to the skin than a longer external tube. For people living with an established access site, the physical design of the device can therefore be an important part of day-to-day device management.
The MiniACE® Button is designed as a low-profile C-Tube with features intended to support the device's use for ACE procedures, including a balloon-retention design and an anti-leakage valve.
Where does the irrigation set come in?
The button is the access device; the irrigation set provides the connection used to deliver the irrigation fluid through that access.
AMT offers MiniACE® irrigation sets in different configurations, including right-angle bolus sets. Medisa also lists the AMT MiniACE® irrigation set separately.
AMT MiniACE® Irrigation Set
Right-angle bolus irrigation set options are available separately, including 12-inch and 24-inch configurations.
Is MACE better than cecostomy?
There is no single answer that applies to everyone. MACE and cecostomy provide different forms of access for the same broad antegrade irrigation concept, and published studies have reported comparable outcomes in some patient groups while identifying different device- or stoma-related considerations.
The choice between approaches can depend on anatomy, previous procedures, the availability and suitability of the appendix, the clinical indication, the technique used, and the preferences and circumstances of the individual.
For that reason, it is more accurate to describe MACE and cecostomy as different ACE access approaches rather than label one as universally better.
Frequently Asked Questions
Is MACE the same as an ACE procedure?
Not exactly. ACE stands for antegrade continence enema and describes the method of delivering irrigation into the colon from an abdominal access point. MACE stands for Malone antegrade continence enema and refers to a specific procedure that traditionally uses the appendix to create a catheterisable channel.
What is the difference between MACE and cecostomy?
The main difference is the route used to access the bowel. A MACE commonly creates an appendix-based channel to the caecum, known as an appendicostomy. A cecostomy provides access directly into the caecum through the abdominal wall.
Can a MiniACE® Button be used for both MACE and cecostomy?
Yes. AMT states that the MiniACE® Button is cleared for both appendicostomy and cecostomy. The underlying access route is determined by the procedure; the MiniACE® Button is the low-profile access device used for the ACE application.
What is an appendicostomy?
An appendicostomy is an appendix-based catheterisable channel that connects the skin to the caecum. It is commonly created as part of a Malone antegrade continence enema procedure, allowing antegrade irrigation through the abdominal access site.
What is a cecostomy?
A cecostomy is an access route created directly into the caecum through the abdominal wall. Depending on the procedure, the access may use a tube or a low-profile button to provide the route for antegrade irrigation.
Does MACE or cecostomy provide better results?
Research does not support describing one approach as universally better for every patient. Outcomes can vary according to the patient population, underlying condition, surgical technique and type of access. Some comparative evidence has reported similar continence outcomes, while the types of complications can differ.
What sizes are available for the MiniACE® Button?
AMT MiniACE® Button configurations include 10Fr, 12Fr and 14Fr sizes, with different stoma length options. The appropriate configuration depends on the established access and the product information provided by the treating healthcare team.
Are MiniACE® irrigation sets available separately?
Yes. AMT offers MiniACE® irrigation sets separately, including right-angle bolus configurations. Medisa lists the AMT MiniACE® irrigation set separately from the button.
Different routes. One antegrade concept.
MACE and cecostomy are not simply two names for the same procedure. They describe different ways of creating access for antegrade bowel irrigation.
Once that distinction is clear, the role of an ACE button becomes easier to understand: the access route is created as part of the procedure, while a low-profile device such as the MiniACE® Button can provide the established access point used for irrigation.
Educational information only
This article is provided for general educational and product-information purposes. It does not replace assessment, advice or instructions from a qualified healthcare professional. Procedure selection, device selection, sizing, replacement and use should follow the applicable product information and the recommendations of the treating healthcare team.
