Pediatric laparoscopic mitrofanoff procedure- preliminary results of a simplified technique

Introduction: Laparoscopic appendicovesicostomy (LA) is a rather new technique and still a challenging procedure even for the most experienced surgeons because it requires advanced laparoscopic experience and surgical skill. The aim of this study is to analyze the short-term results and benefits of laparoscopic LA in children.

Materials and methods: Prospective study of children undergoing LA at our institution between January 2018 and October 2021. The procedure was perfomed using a laparoscopic transperitoneal approach. The distal end of the appendix was spatulated and reimplanted in the bladder by a modified Shanfield technique. The proximal end was brought out as the cutaneous umbilical stoma.

Results: Over the study period 15 patients underwent LA (14 males,1 female). Mean age at intervention was 8.8 years (SD:3.1). Indication for surgery was pain during CIC in 13 (86.7%) and difficulty for CIC in 2 (13.3%). Eight patients (53.5%) presented end-stage renal disease (ESRD). Median operative time was 217.3 min (r:140-300). Two patients (13.3%) experienced early postoperative complications: ileus (1) and internal hernia over the mesoappendix with subsequent intestinal obstruction. Mean hospital stay was 6.8 days (SD:1.7). Four patients (26.7%) experienced late postoperative stoma related complications: stomal stenosis (1), granuloma (1) and inability to catheterize (2). With a mean follow-up of 21.46 months (SD: 13) all except the patent who lost the conduit are continent and on CIC every 3 h.

Conclusions: We suggest that LA by this technique is effective, safe and reproducible, and is associated with good short-term results. The complication rate is similar to the open procedure being intestinal obstruction due to internal hernia probably the most serious.