Laparoscopic posterior appendix Mitrofanoff using the modified Shanfield anastomosis

Area of Science:

• Urology
• Pediatric Surgery
• Minimally Invasive Surgery

Background:

• Neuropathic bladder in children often requires urinary diversion for management.
• Appendicovesicostomy (Mitrofanoff procedure) is a common surgical option for creating a continent catheterizable channel.
• Minimally invasive techniques aim to reduce surgical trauma and improve cosmetic outcomes.

Observation:

• A laparoscopic transperitoneal appendicovesicostomy was successfully performed in a 5-year-old boy using a single 5-mm and two 3-mm ports.
• The procedure involved a modified Shanfield anastomosis, posterior extramucosal detrusorotomy, and submucosal dissection.
• The appendix was tunneled into the bladder, creating an antirefluxing extramucosal tunnel and a VQ plasty stoma.

Findings:

• The surgical procedure and postoperative recovery were uneventful.
• Clean intermittent catheterization (CIC) was successfully established and maintained for 6 months post-surgery.
• The technique demonstrated feasibility with minimal and small ports, yielding good cosmetic results.

Implications:

• This approach simplifies the Mitrofanoff procedure, reducing operative complexity and improving patient comfort.
• The absence of a mucosa-mucosa junction in the anastomosis ensures reliable and easier catheterization.
• Laparoscopic appendicovesicostomy represents a viable, less invasive alternative for managing neuropathic bladder in pediatric patients.