915 SPLIT-APPENDIX TECHNIQUE FOR SIMULTANEOUS APPENDICOVESICOSTOMY AND APPENDICOCECOSTOMY

You have accessJournal of UrologyPediatrics: Reconstructive Surgery1 Apr 2010915 SPLIT-APPENDIX TECHNIQUE FOR SIMULTANEOUS APPENDICOVESICOSTOMY AND APPENDICOCECOSTOMY Brian A. VanderBrink, Mark P. Cain, Martin Kaefer, Kirstan K. Meldrum, Rosalia Misseri, and Richard C. Rink Brian A. VanderBrinkBrian A. VanderBrink Fishers, IN More articles by this author , Mark P. CainMark P. Cain Indianapolis, IN More articles by this author , Martin KaeferMartin Kaefer Indianapolis, IN More articles by this author , Kirstan K. MeldrumKirstan K. Meldrum Indianapolis, IN More articles by this author , Rosalia MisseriRosalia Misseri Indianapolis, IN More articles by this author , and Richard C. RinkRichard C. Rink Indianapolis, IN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1705AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urinary and fecal incontinence can coexist in neurologic conditions causing significant distress to patients and their families. Surgical intervention with appendicocecostomy (AC) and appendicovesicostomy (AV) can help in achieving continence. Usually the appendix can only be utilized for a single channel requiring additional channel being constructed from different tissue (i.e. ileum). We describe our outcomes using the spilt-appendix technique for simultaneous creation of AC and AV. METHODS A retrospective review of operative records at our institution from 1999-2009 with an emphasis on simultaneous creation of AC and AV from the appendix alone was performed. Our technique was when appendiceal vascular supply and length permitted; the appendix was divided with the proximal end kept in continuity with the cecum for an in situ AC while the distal end utilized for AV. The appendiceal length, utilization of stapler for appendicocecal extension to lengthen functional AC channel length, continence status, and subsequent need for surgical revision, if necessary, was recorded. RESULTS Of 394 children that underwent creation of continent catheterizable channels, 43 patients (11%) were identified that used the split appendix technique. Appendiceal length was available in 27 patients and was 10 ± 2 cm. The appendix was approximately divided in half in 34 patients while asymmetrical separation with stapled appendicocecal extension utilized in 9 patients. Mean length of appendix used for AV and AC was 6 cm and 4 cm, respectively. With a mean follow-up of 40 months, 43/43 AC and 41/43 AV are continent. Sixteen of the 86 channels (19%) created required surgical revision. AC and AV revisions occurred in 6 patients each, while 2 patients required surgical revision of both channels. Use of the stapler for appendicocecal extension did not result in increased need for channel revision. CONCLUSIONS To our knowledge this is the largest clinical series describing the split appendix technique for creation of AC & AV in a pediatric population. The channels created from split appendix have durable short-term outcomes and comparable revision rates to other described techniques. The split appendix technique is applicable to a minority of children undergoing continent reconstruction, however has the benefit of avoiding a bowel resection and its accompanying risks. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e357 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brian A. VanderBrink Fishers, IN More articles by this author Mark P. Cain Indianapolis, IN More articles by this author Martin Kaefer Indianapolis, IN More articles by this author Kirstan K. Meldrum Indianapolis, IN More articles by this author Rosalia Misseri Indianapolis, IN More articles by this author Richard C. Rink Indianapolis, IN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Topic: Intestinal Malrotation and Obstruction Disorders
Subfield: Surgery
Field: Medicine
Domain: Health Sciences