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Totally laparoscopic combined freehand ileocystoplasty and Malone procedures
Pejman Shadpour1, Nasser Simforoosh, Robab Magsudi
1Department of Urology, Iran University of Medical Sciences, Tabriz, Iran. pejmanshadpour@yahoo.com
Insights
This study introduces a laparoscopic approach for fecal and urinary incontinence in children with myelomeningocele, achieving continence and addressing evacuation issues in one session.
Area of Science:
- Pediatric Surgery
- Urology
- Gastroenterology
Background:
- Neurogenic dysfunction often leads to fecal and urinary incontinence in children.
- Myelomeningocele is a common cause of neurogenic bladder and bowel.
- Current treatments can be invasive and require multiple procedures.
Purpose of the Study:
- To present the first report on a combined laparoscopic approach for fecal and urinary incontinence in children with myelomeningocele.
- To evaluate the efficacy and safety of freehand laparoscopy for cecostomy and enterocystoplasty.
- To offer an effective and cosmetically advantageous alternative to open surgical procedures.
Main Methods:
- Six patients with myelomeningocele and total incontinence underwent laparoscopic surgery.
- A segment of ileum was isolated and fashioned into a U-shaped patch for bladder anastomosis.
- Endoscopic freehand suturing was used for intestinal and bladder connections; the appendix was brought to the skin.
Main Results:
- Procedures ranged from 5 to 8.5 hours with a median hospital stay of 5 days.
- At 13-16 months follow-up, all patients achieved urinary continence and near-perfect fecal continence with antegrade enema.
- One patient had a minor ileal leak that resolved conservatively; another had appendiceal stenosis requiring revision.
Conclusions:
- Laparoscopic combined cecostomy and enterocystoplasty effectively addresses fecal and urinary incontinence in one session.
- The procedure offers cosmetic benefits and reasonable operative times compared to open surgery.
- This laparoscopic technique is a viable alternative to open surgery for managing complex incontinence in children.
Background And Purpose:
Cecostomy performed together with open enterocystoplasty can allow continent bowel evacuation in children with neurogenic dysfunction. We present the first report on a combined approach to fecal and urinary incontinence in children with myelomeningocele that was performed exclusively by freehand laparoscopy.
Patients And Method:
We treated six dysrhaphic patients for total urinary and fecal incontinence by laparoscopy. Through five ports, a selected segment of ileum was isolated with cautery. A single-layer intestinal anastomosis, fashioning of the U-shaped patch, and anastomosis to the opened bladder dome were all done by endocorporeal freehand suturing. The tip of the appendix was simply brought to the skin via a trocar site.
Results:
The procedures took 5 to 8.5 hours. Patients remained hospitalized for 5 to 16 days (median 5 days). At 13 to 16 months' follow-up, all patients remain continent of urine, and nearly perfect fecal continence has resulted on antegrade enema. Leak from the ileal anastomosis in one patient resolved rapidly with conservative management. One short retrocecal appendix later developed stenosis and was replaced by a tubed cecal flap.
Conclusion:
Apart from its cosmetic advantage, this procedure is notable for addressing all evacuation problems at one session. Our suturing time seems reasonable compared with open sutured precedents. Use of a gastrointestinal stapling device for anastomosis would have significantly increased the cost while not necessarily guaranteeing against complications. We present this laparoscopic combination as an effective alternative to its open counterpart.