Laparoscopic appendicovesicostomy and ileovesicostomy: A step-by-step technique description in neurogenic patients

Abstract

Aims:This study aims to describe our surgical technique and report our preliminary experience with laparoscopic ileal or appendicovesicostomy in adult patients with neurogenic bladder caused by spinal cord injury.Subjects and Methods:From January 2014 to March 2017, seven patients were submitted to an appendicovesicostomy under Mitrofanoff procedure and two patients to an ileovesicostomy under Yang-Monti procedure by laparoscopy. Clinical indications were patients with a history of neurogenic bladder secondary to spinal cord pathology, with proper dexterity and willing to have a more accessible continent derivation. Surgical steps include: (1) identification and mobilization of appendix; (2) ligation of appendix' base; (3) endoloop reinforcement of proximal end; (4) silicon catheter insertion in appendix' lumen; (5) mesoappendix dissection; (6) Retzius space opening; (7) posterior bladder dissection; (8) anterior transcutaneous bladder dome fixation; (9) vertical midline detrusor incision; (10) opening of bladder mucosa; (11) excision and espatulation of appendix tip; (12) appendico vesical anastomosis; and (13) exteriorization of appendix through umbilicus and creation of catheterizable stoma. In the two patients submitted to a Yang-Monti diversion, the ileum reconfiguration and calibration was done extracorporeally. One patient had simultaneous bladder augmentation.Results:The mean follow-up was 21.5 ± 11.9 months. The mean operative time was 161 min (123–220). There was no conversion to laparotomy and no need of postoperative blood transfusion. The mean hospitalization length was 4 days. No early postoperative complication was registered. Late postoperative complications were: one surgical stoma revision, one false-passage (solved by transient catheterization), and one bladder stone (solved by endoscopic approach). All patients are continent.Conclusions:This series presents our laparoscopic technique for continent urinary diversions, showing that it is feasible and safe in adult patients with neurogenic bladder.

The feasibility and efficacy of catheterizable stoma's in adults

“…Recent literature also shows good results with a continence rate at conduit level between 58.40% and 100% [3 ▪ ,5 ▪ ,12 ▪ ,13 ▪▪ ,15 ▪ ,17 ▪▪ ,18 ▪ ].…”

“…The series of Costa et al reported the lowest rate of stomal stenosis (11%) [3 ▪ ]. This low rate could be explained by the use of a silicon plug and closer follow-up when a stomal stenosis was identified.…”

“…Deep venous thrombosis and respiratory complications are the most common early medical complications [9]. Early re-operation rate has been reported to vary between 1.2% and 8% [14], although Abedi and Costa et al reported zero early complications [3 ▪ ,15 ▪ ].…”

“…If management with CI(S)C through the native urethra is not feasible, a continent urinary diversion can represent a useful alternative. This option allows for social continence, whereas reliably emptying the bladder through catheterization of an abdominal conduit, thus avoiding the urethra/genital area [3 ▪ ]…”

Modern view on the problem of urine diversion in children with severe urinary disorders

“…В настоящее время все больше распространяется и развивается лапароскопия, в том числе в реконструктивной урологии у детей, и аппендиковезикостомию по Митрофанову это развитие не обошло стороной. Среди абсолютных преимуществ лапароскопической аппендиковезикостомии -меньшая травматичность операции, отличный косметический результат и сокращение сроков пребывания больного в стационаре [33][34][35]. Данная операция достаточно сложна технически, поэтому выполнять ее должен опытный хирург, обладающий хорошими навыками в области лапароскопии.…”