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[Appendicovesicostomy (Mitrofanoff procedure) in children: Long-term follow-up and specific complications]
Insights
Appendicovesicostomy (Mitrofanoff procedure) in children carries a high risk of complications and revisions. Despite this, it can achieve high rates of urinary continence.
Area of Science:
- Pediatric Surgery
- Urology
Background:
- Intermittent catheterization via appendicovesicostomy (Mitrofanoff principle) offers an alternative to urethral catheterization in children.
- Evaluating complications specific to the appendicovesicostomy technique is crucial for understanding its risks and benefits.
Purpose of the Study:
- To determine the rate of specific complications associated with appendicostomy-based urinary diversion in pediatric patients.
- To analyze the timing, frequency, and management of these complications.
Main Methods:
- Retrospective analysis of data from 1997 to 2017 for children undergoing appendicovesicostomy.
- Focus on surgical complications, onset, frequency, and need for reintervention.
Main Results:
- Fifty percent of patients experienced complications, with 38% requiring surgical revision.
- Stenosis (over or under-fascial) was a common issue leading to difficult catheterization.
- High rates of urinary continence (97%) were achieved, with lower initial incontinence rates when using the appendix.
Conclusions:
- Appendicovesicostomy is associated with a significant risk of complications and the need for revision surgery.
- Despite potential complications, the procedure can effectively establish a functional, continent urinary channel.
Objective:
In children, intermittent catheterization by appendicovesicostomy according to Mitrofanoff is an interesting alternative to the urethral approach. Objective of the study was to evaluate the rate of appendicovesicostomy's specific complications.
Method:
From 1997 to 2017, data on children treated and followed for an appendicovesicostomy in an academic institution were collected retrospectively. Rates of surgical complications specifically encountered on appendicovesicostomy, time of onset, frequency, and necessity of surgical reinterventions have been reported.
Results:
Thirty-four patients were operated on and followed for a median of 6.2 years [0.3-24]. Fifty percent had a complication, occurring after a median of 8 months [2-90], and 38% required at least one surgical revision. If complication occurred, adjustment of medical treatment and intermittent catheterization was effective in 12% of patients, endoscopic or over-fascial surgery was necessary in 17% of cases, and under-fascial revision in 21% of cases. Median time to complication was 4 months [1-90] after creation or revision of appendicovesicostomy. Thirty-height percent of difficult channel catheterization were reported, of which 46% were over or under-fascial stenosis. Inaugural urinary incontinence was 18%, and only 9% if using the appendix. At the end, 97% of appendicovesicostomy were continent.
Conclusions:
Appendicovesicostomy is a high risk of complications and postoperative revisions surgery, in order to have a functional continent channel.
Level Of Evidence:
4.
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