Laparoscopic appendicovesicostomy and ileovesicostomy: A step-by-step technique description in neurogenic patients
Pedro Costa1, Carlos Ferreira2, Damiano Bracchitta3, Pierre-Émmanuel Bryckaert3
1 Department of Urology, Clinique du Pré, Technopôle Université, Le Mans, France; Department of Urology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
2 Department of Urology, Clinique du Pré, Technopôle Université, Le Mans, France; Department of Urology, Unidade Local de Saúde de Matosinhos, Serviço de Urologia, Hospital Pedro Hispano, Senhora da Hora, Portugal
3 Department of Urology, Clinique du Pré, Technopôle Université, Le Mans, France
Dr. Pedro Costa
Department of Urology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Rua Conceição Fernandes 4434-502, Vila Nova de Gaia, Espinho, Portugal
Aims: This study aims to describe our surgical technique and report our preliminary experience with laparoscopic ileal or appendicovesicostomy in adult patients with neurogenic bladder caused by spinal cord injury.
Subjects and Methods: From January 2014 to March 2017, seven patients were submitted to an appendicovesicostomy under Mitrofanoff procedure and two patients to an ileovesicostomy under Yang-Monti procedure by laparoscopy. Clinical indications were patients with a history of neurogenic bladder secondary to spinal cord pathology, with proper dexterity and willing to have a more accessible continent derivation. Surgical steps include: (1) identification and mobilization of appendix; (2) ligation of appendix' base; (3) endoloop reinforcement of proximal end; (4) silicon catheter insertion in appendix' lumen; (5) mesoappendix dissection; (6) Retzius space opening; (7) posterior bladder dissection; (8) anterior transcutaneous bladder dome fixation; (9) vertical midline detrusor incision; (10) opening of bladder mucosa; (11) excision and espatulation of appendix tip; (12) appendico vesical anastomosis; and (13) exteriorization of appendix through umbilicus and creation of catheterizable stoma. In the two patients submitted to a Yang-Monti diversion, the ileum reconfiguration and calibration was done extracorporeally. One patient had simultaneous bladder augmentation.
Results: The mean follow-up was 21.5 ± 11.9 months. The mean operative time was 161 min (123–220). There was no conversion to laparotomy and no need of postoperative blood transfusion. The mean hospitalization length was 4 days. No early postoperative complication was registered. Late postoperative complications were: one surgical stoma revision, one false-passage (solved by transient catheterization), and one bladder stone (solved by endoscopic approach). All patients are continent.
Conclusions: This series presents our laparoscopic technique for continent urinary diversions, showing that it is feasible and safe in adult patients with neurogenic bladder.