A New Appendicostomy Technique to Prevent Stomal Stenosis

No AccessJournal of UrologyPediatric Urology1 Jun 2020A New Appendicostomy Technique to Prevent Stomal StenosisThis article is commented on by the following:Editorial CommentEditorial Comment Eric A. Kurzrock Eric A. KurzrockEric A. Kurzrock *Correspondence: UC Davis Children's Hospital, Shriners Hospitals for Children–Northern California, 4860 Y St., No. 3500, Sacramento, California 95817 telephone: 916-734-4561; FAX: 916-734-8094; E-mail Address: [email protected] UC Davis Children's Hospital, Shriners Hospitals for Children–Northern California, Sacramento, California View All Author Informationhttps://doi.org/10.1097/JU.0000000000000711AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Stomal stenosis has been reported to occur in 12% to 45% of patients following Malone antegrade continence enema and Mitrofanoff appendicostomy. The standard stoma technique entails excision of the distal appendix. We evaluated a novel technique with preservation of the appendiceal tip and vessels, and opening the lumen in a more proximal and vascular area to determine whether the incidence of stenosis would be decreased. Materials and Methods: Medical records of patients who underwent appendicostomy for Malone antegrade continence enema or urinary diversion were retrospectively evaluated. We included cases with a minimum of 1 year of followup and those in which the distal portion of a complete appendix was oriented for use as the stomal end in the umbilicus. Variables such as age, gender, body mass index, antegrade continence enema or urinary diversion, open or laparoscopic approach, cecal and appendiceal adhesions, retrocecal position, cecal imbrication, technique and stenosis were recorded. Cox proportional hazards analyses were performed to determine association of covariates. Results: A total of 123 patients met inclusion criteria. The incidence of stenosis following standard stoma technique was 13% (12 of 93 patients) with a median followup of 9.4 years. Of these cases 75% occurred within 1 year of surgery. Stomal stenosis did not occur after the new stoma technique in 30 patients with a median followup of 3.3 years. Only technique cohort (standard vs new) was associated with stenosis (p=0.04). Conclusions: Stomal stenosis of appendicostomy may be lessened by preservation of the distal appendiceal vasculature and tip, and opening the lumen in a more proximal location. References 1. : [Trans-appendicular continent cystostomy in the management of the neurogenic bladder]. Chir Pediatr 1980; 21: 297. Google Scholar 2. : Preliminary report: the antegrade continence enema. Lancet 1990; 336: 1217. 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Study received institutional review board approval (IRB No. 591176). © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byTanaka S (2020) This Month in Pediatric UrologyJournal of Urology, VOL. 203, NO. 6, (1035-1035), Online publication date: 1-Jun-2020.Related articlesJournal of Urology19 Mar 2020Editorial CommentJournal of Urology19 Mar 2020Editorial Comment Volume 203Issue 6June 2020Page: 1200-1206 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.Keywordsenematherapeutic irrigationsurgical stomasfecal incontinencespinal dysraphismAcknowledgmentDr. Blythe Durbin-Johnson performed statistical analyses.MetricsAuthor Information Eric A. Kurzrock UC Davis Children's Hospital, Shriners Hospitals for Children–Northern California, Sacramento, California *Correspondence: UC Davis Children's Hospital, Shriners Hospitals for Children–Northern California, 4860 Y St., No. 3500, Sacramento, California 95817 telephone: 916-734-4561; FAX: 916-734-8094; E-mail Address: [email protected] More articles by this author Expand All No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. Study received institutional review board approval (IRB No. 591176). Advertisement PDF downloadLoading ...