Continent appendix stoma: a modification of the Mainz pouch technique

Area of Science:

• Urology
• Surgical Techniques
• Reconstructive Surgery

Background:

• Ileocecal urinary reservoirs are used for urinary diversion.
• Maintaining continence is crucial for patient quality of life.
• The Mainz pouch technique is a common method for creating urinary reservoirs.

Purpose of the Study:

• To evaluate the efficacy of a submucosally embedded in situ appendix as a continence mechanism in ileocecal urinary reservoirs.
• To assess the outcomes of this modification of the Mainz pouch technique.

Main Methods:

• A modification of the Mainz pouch technique involving submucosal embedding of the appendix was performed in 13 patients.
• Stoma placement was documented (12 in the lower right abdominal quadrant, 1 in the umbilical funnel).
• Urodynamic investigations were conducted to assess the appendix's closure pressure.

Main Results:

• The submucosally embedded appendix demonstrated an ideal continence mechanism.
• Urodynamic studies revealed a maximum closure pressure exceeding 80 cm water.
• Only one patient (1 out of 13) required reoperation due to stomal stenosis.

Conclusions:

• Submucosally embedding the appendix is a successful modification for the Mainz pouch technique, ensuring excellent urinary reservoir continence.
• This technique offers a reliable and effective solution for patients requiring ileocecal urinary diversion.
• The procedure is associated with a low complication rate, with stomal stenosis being the primary issue requiring intervention.