Synchronous panniculectomy with stomal revision for obese patients with stomal stenosis and retraction

To report our experience of synchronous panniculectomy with stomal revision in morbidly obese patients after radical cystectomy (RC) and ileal conduit urinary diversion (UD). Abnormal skin folds with an uneven surface, stomal retraction and stomal stenosis result in a poorly fitting appliance which leads to urinary leakage, need for frequent change of appliances and skin excoriation.

In all, 302 RCs with UD were done by one surgical team between 2002 and 2008, with ileal conduit diversion in 182 (60%); 18 had a body mass index (BMI) of >35 kg/m(2), and among them four had severe stomal stenosis with retraction. We report the technique we used for managing stomal stenosis in these patients.

The mean (range) BMI of the patients was 42 (38-46) kg/m(2); all were women. The mean (sd) operative duration was 2 (0.5)h. The drain was removed once the drainage was <25 mL in 24 h. The mean (sd) hospital stay was 3 (1) days; there were no significant complications. After a mean follow-up of 3 years there was no recurrent stomal stenosis or retraction.

The unique advantage of this procedure is that it avoids laparotomy in a morbidly obese patient, and it provides excellent cosmesis while correcting the stomal complication.