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Concealed umbilical stoma: long-term evaluation of stomal stenosis
1Department of Surgery, Division of Urology, University of Maryland School of Medicine, Baltimore, MD, USA.
Insights
The concealed umbilical stoma technique offers excellent cosmetic results and prevents stenosis. This method is highly effective for patients needing intermittent bladder or bowel catheterization, with a low revision rate.
Area of Science:
- Urology
- Pediatric Surgery
- Surgical Techniques
Background:
- The concealed umbilical stoma technique, utilizing a posterior umbilical flap, aims to improve cosmesis and prevent stenosis.
- Previous descriptions exist, but long-term stomal stenosis rates require further assessment.
Purpose of the Study:
- To evaluate the long-term efficacy of the concealed umbilical stoma technique.
- To assess the incidence and management of stomal stenosis in patients with concealed umbilical stomas.
Main Methods:
- Retrospective chart review of 46 patients (35 concealed umbilical stoma, 11 Malone antegrade continence enema).
- Analysis of stoma types, diversion procedures (urinary, bowel), and augmentation cystoplasty.
- Follow-up duration ranged from 12 to 84 months (median 3.4 years).
Main Results:
- 93.5% of patients maintained an intact stoma without surgical revision.
- Stomal stenosis requiring revision occurred in 6.5% of patients (3/46) at 1, 4, and 38 months post-surgery.
- Two patients required temporary indwelling catheterization for stenosis management.
Conclusions:
- The concealed umbilical stoma technique yields excellent cosmetic outcomes.
- This technique demonstrates a low rate of stomal stenosis for patients requiring intermittent catheterization.
- The method is a viable option for continent urinary diversion and bowel management.
Purpose:
The technique of forming a concealed umbilical stoma has been described previously and includes a posterior umbilical flap for improved cosmesis and stenosis prevention. We assessed long-term stomal stenosis.
Materials And Methods:
We reviewed retrospectively the charts of 46 patients (mean age at surgery 14 years) of whom 35 had undergone concealed umbilical stoma creation and 11 the Malone antegrade continence enema procedure for continent urinary diversion. Urinary stomas were created from appendix in 20 cases, ileum in 8, sigmoid colon in 5, bladder in 1 and stomach in 1. Malone antegrade continence enema stomas were constructed from appendix in 10 cases and sigmoid colon in 1. A total of 21 patients underwent urinary diversion and augmentation cystoplasty.
Results:
At followup of 12 to 84 months (median 3.4 years) 93.5% of patients had an intact stoma with no need for surgical revision. Of the remaining patients 3 (6.5%) required revision of the stoma at skin level for stomal stenosis at 1, 4 and 38 months after initial surgery and 2 had a brief period of indwelling catheterization for correction of stenosis.
Conclusions:
The concealed umbilical stoma technique provides an excellent cosmetic result with a low rate of stomal stenosis in patients requiring intermittent bladder or bowel catheterization.