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Oral mucosa inlay grafts for stoma challenges: One for the toolbox
Tatjana Heisinger-Heidler1, Ilina Rosoklija2, Theresa Meyer2
1Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, 60611, IL, USA; Department of Urology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, 6020, Austria.
Introduction:
Stomal stenosis is a common complication of continent catheterizable channels. While mild issues can often be managed conservatively, persistent catheterization difficulties or discomfort may require surgical revision. However, surrounding scar tissue can be suboptimal for incorporation and can limit surgical options. In those cases, oral mucosa inlay grafts may offer an alternative.
Objective:
To evaluate the feasibility and outcomes of oral mucosa inlay grafts.
Study Design:
A single institution, retrospective case series of patients (2007-2024) with suprafascial channel revisions incorporating oral mucosa inlay grafts was done. Patient and stomal characteristics were reviewed and longitudinal clinical and surgical outcomes were assessed.
Results:
We identified 11 patients (9 female) who received oral mucosa inlay following: Mitrofanoff appendicovesicostomy (5/11), Monti-Yang ileovesicostomy (3/11), appendicocecostomy (3/11) in the right lower quadrant (6/11), umbilicus (3/11), neo-umbilicus (1/11) and the midline incision (1/11). All revisions were due to cicatrix or "hooding", which can cover or obstruct the stoma opening. Median time to revision was 18 months (range 11-89 months). With increasing experience in different scar characteristics, our dissection prior to grafting evolved from deep radial incisions into the healthy channel to excision of hypertrophic scar tissue and mobilization of the suprafascial channel. At a median follow-up of 46 months (range 9-211 months) post-grafting, 3/11 patients required reintervention and 2/11 experienced intermittent catheterization difficulties that were managed conservatively. All patients were successfully catheterizing at their most recent follow-up, with a median of 28 months (range 7-166 months) since their reintervention or intermittent difficulty.
Discussion:
Despite our long follow-up, larger sample sizes are needed to refine an individualized approach and to draw more definitive conclusions on long-term efficacy of diverse stoma stenosis phenotypes.
Conclusion:
Based on our experience, oral mucosa inlay grafts are a feasible stoma revision strategy. Complete excision of hypertrophic scar tissue may further improve surgical outcomes.
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