Pediatric laparoscopic mitrofanoff procedure- preliminary results of a simplified technique

  • Romy Gander
    Correspondence
    Correspondence to: Romy Gander, Passeig de la Vall d´Hebron 119-139, Barcelona, 08032, Spain, Tel.: +34/600541779
    Affiliations
    Department of Pediatric Surgery, Pediatric Urology and Renal Transplant Unit, University Hospital Vall D´Hebron Barcelona, Hospital Vall D´Hebron, Passeig de La Vall D´Hebrón 119-129, Barcelona, 08035, Spain
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  • Marino Asensio
    Affiliations
    Department of Pediatric Surgery, Pediatric Urology and Renal Transplant Unit, University Hospital Vall D´Hebron Barcelona, Hospital Vall D´Hebron, Passeig de La Vall D´Hebrón 119-129, Barcelona, 08035, Spain
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  • Gloria Fatou Royo
    Affiliations
    Department of Pediatric Surgery, Pediatric Urology and Renal Transplant Unit, University Hospital Vall D´Hebron Barcelona, Hospital Vall D´Hebron, Passeig de La Vall D´Hebrón 119-129, Barcelona, 08035, Spain
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  • Manuel López
    Affiliations
    Department of Pediatric Surgery, University Hospital Vall D´Hebron. Barcelona, Hospital Vall D´Hebron, Passeig de La Vall D´Hebrón 119-129, Barcelona, 08035, Spain

    Universidad Autónoma de Barcelona, Hospital Vall D´Hebron, Passeig de La Vall D´Hebrón 119-129, Barcelona, 08035, Spain
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Published:January 06, 2022DOI:https://doi.org/10.1016/j.jpurol.2021.12.018

      Summary

      Introduction

      Laparoscopic appendicovesicostomy (LA) is a rather new technique and still a challenging procedure even for the most experienced surgeons because it requires advanced laparoscopic experience and surgical skill. The aim of this study is to analyze the short-term results and benefits of laparoscopic LA in children.

      Materials and methods

      Prospective study of children undergoing LA at our institution between January 2018 and October 2021. The procedure was perfomed using a laparoscopic transperitoneal approach. The distal end of the appendix was spatulated and reimplanted in the bladder by a modified Shanfield technique. The proximal end was brought out as the cutaneous umbilical stoma.

      Results

      Over the study period 15 patients underwent LA (14 males,1 female). Mean age at intervention was 8.8 years (SD:3.1). Indication for surgery was pain during CIC in 13 (86.7%) and difficulty for CIC in 2 (13.3%). Eight patients (53.5%) presented end-stage renal disease (ESRD). Median operative time was 217.3 min (r:140–300). Two patients (13.3%) experienced early postoperative complications: ileus (1) and internal hernia over the mesoappendix with subsequent intestinal obstruction. Mean hospital stay was 6.8 days (SD:1.7). Four patients (26.7%) experienced late postoperative stoma related complications: stomal stenosis (1), granuloma (1) and inability to catheterize (2).
      With a mean follow-up of 21.46 months (SD: 13) all except the patent who lost the conduit are continent and on CIC every 3 h.

      Conclusions

      We suggest that LA by this technique is effective, safe and reproducible, and is associated with good short-term results. The complication rate is similar to the open procedure being intestinal obstruction due to internal hernia probably the most serious.

      Keywords

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      References

        • Blanc T.
        • Muller C.
        • Pons M.
        • Pashootan P.
        • Paye-Jaouen A.
        • El Ghoneimi A.
        Laparoscopic Mitrofanoff procedure in children: critical analysis of difficulties and benefits.
        J Pediatr Urol. 2015; 11 (-8): 28.e1
        • Weller S.
        • Bortagaray J.I.
        • Corbetta J.P.
        • Corro R.J.
        • Durán V.
        • Sager C.
        • et al.
        Laparoscopic Mitrofanoff procedure using single «U-Stitch» anastomosis: a way to make it simple.
        J Pediatr Urol. 2013; 9: 432-436
        • Papageorgiou E.
        • Cherian A.
        Laparoscopic posterior appendix Mitrofanoff using the modified Shanfield anastomosis.
        J Pediatr Urol. 2019; 15: 419-420
        • Badawy H.
        • Eid A.
        • Dawood W.
        • Hanno A.
        Safety and feasibility of laparoscopic appendicovesicostomy in children.
        J Pediatr Urol. 2013; 9: 427-431
        • Reddy M.N.
        • Nerli R.B.
        • Patil R.A.
        • Jali S.M.
        Laparoscopic Mitrofanoff continent catheterisable stoma in children with spina bifida.
        Afr J Paediatr Surg AJPS. 2015; 12: 126-130
        • Farrugia M.-K.
        • Malone P.S.
        Educational article: the Mitrofanoff procedure.
        J Pediatr Urol. 2010; 6: 330-337
        • Gander R.
        • Asensio M.
        • Royo G.F.
        • López M.
        Laparoscopic extravesical ureteral reimplantation for correction of primary and secondary megaureters: preliminary report of a new simplified technique.
        J Pediatr Surg. 2019 Mar; 55: 564-569
        • Mitrofanoff P.
        Trans-appendicular continent cystostomy in the management of the neurogenic bladder.
        Chir Pediatr. 1980; 21: 297-305
        • Harris C.F.
        • Cooper C.S.
        • Hutcheson J.C.
        • Snyder H.M.
        Appendicovesicostomy: the mitrofanoff procedure-a 15-year perspective.
        J Urol. 2000; 163: 1922-1926
        • Thompson D.
        • Soliman S.M.
        • Bader M.
        • Cherian A.
        The Shanfield anastomosis revisited: its applications and early outcome.
        J Pediatr Surg. 2019; 54: 307-309
        • Hsu T.H.S.
        • Shortliffe L.D.
        Laparoscopic mitrofanoff appendicovesicostomy.
        Urology. 2004; 64: 802-804
        • Nerli R.B.
        • Reddy M.
        • Devraju S.
        • Prabha V.
        • Hiremath M.B.
        • Jali S.
        Laparoscopic mitrofanoff appendicovesicostomy: our experience in children.
        Indian J Urol IJU J Urol Soc India. 2012; 28: 28-31
        • Szymanski K.M.
        • Lopez P.-J.
        • Corbetta J.P.
        • Reed F.
        • Ruiz J.
        • Pullin Y.
        • et al.
        Do anterior catheterizable urinary channels have fewer complications than posterior channels? An international cohort study.
        J Pediatr Urol. 2018; 14: 48.e1-48.e7
        • Berkowitz J.
        • North A.C.
        • Tripp R.
        • Gearhart J.P.
        • Lakshmanan Y.
        Mitrofanoff continent catheterizable conduits: top down or bottom up?.
        J Pediatr Urol. 2009; 5: 122-125
        • Texter J.H.
        • Bokinsky G.
        • Whitesell A.I.
        • Wolf J.S.
        • Shanfield I.
        Simplified experimental ureteroneocystostomy.
        Urology. 1976; 7: 21-23
        • Alberts V.P.
        • Idu M.M.
        • Legemate D.A.
        • Laguna Pes M.P.
        • Minnee R.C.
        Ureterovesical anastomotic techniques for kidney transplantation: a systematic review and meta-analysis.
        Transpl Int Off J Eur Soc Organ Transplant. 2014; 27: 593-605
        • Gundeti M.S.
        • Acharya S.S.
        • Zagaja G.P.
        • Shalhav A.L.
        Paediatric robotic-assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy (RALIMA): feasibility of and initial experience with the University of Chicago technique.
        BJU Int. 2011; 107: 962-969
        • Grimsby G.M.
        • Jacobs M.A.
        • Gargollo P.C.
        Comparison of complications of robot-assisted laparoscopic and open appendicovesicostomy in children.
        J Urol. 2015; 194: 772-776