Mitrofanoff complications: time-to-event analysis of split versus intact appendix and meta-analysis

To assess the complication rates associated with split versus intact appendix Mitrofanoff procedures using a single-center retrospective analysis and a systematic review with meta-analysis.

The study comprised a retrospective cohort analysis at a single institution, analyzing patients who underwent a laparoscopic-assisted Mitrofanoff with or without splitting the appendix from 2005 to 2016. The focus was on complications related to both Mitrofanoff and ACE channels. Kaplan-Meier survival analysis, log-rank tests, and Cox regression were utilized to determine hazard ratios. Additionally, a PROSPERO (CRD42023481627)-registered systematic review and meta-analysis were conducted, evaluating complication rates across diverse patient populations using the Mantel-Haenszel method with a random-effects model.

A total of 22 patients with intact appendix Mitrofanoff and 10 with split appendix for both Mitrofanoff and ACE creation were compared. The time to complications did not differ significantly, with a log-rank p-value of 0.72. The adjusted hazard ratio for the split appendix group was 1.26 (95% CI: 0.32-4.99). The systematic review and meta-analysis included 565 patients and indicated a higher, albeit non-significant, complication rate in the split appendix group (29.2%) compared to the intact group (20.4%), with an odds ratio of 1.49 (95% CI: 0.82-2.73).

The analysis showed that, compared to appendicovesicostomy performed in isolation, the split appendix technique may be associated with slightly higher complication rates, though not statistically significant. The choice of surgical technique should be tailored to the individual anatomical and functional needs of patients, emphasizing the importance of personalized surgical planning and skilled execution.