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A Modified Stomal Construction Technique to Reduce Incidence of Stomal Stenosis in Reconstructive Pediatric Urology
Stephen Sekoulopoulos, MD MS1, Sri S. Manivasagam, MD MS1, Akshilkumar Patel, MD2, Ellius Kwok, MD2, Ross M. Decter, MD1.
1Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA, 2The Pennsylvania State University, College of Medicine, Hershey, PA, USA.
Background: Antegrade continent enema (ACE) and catheterizable bladder channel (Mitrofanoff) procedures are routinely performed in pediatric urology patients diagnosed with a neurogenic bladder and bowel. Stomal stenosis is a common surgical complication of these procedures, occurring in approximately 10-30% of stomas. Our frustration with this complication prompted us to modify our suturing technique during stomal construction to attempt to decrease the incidence of stomal stenosis.
Methods: We compared the rates of stomal stenosis between patients who underwent the creation of an ACE or Mitrofanoff channel using the historical techniques (prior to April 2018) versus the current technique (from April 2018 to December 2020). Our current technique for stoma creation consists of suturing full thickness bowel to only the dermal layer of the skin using 5-0 PDS interrupted sutures with the knots buried. Statistics were performed using Fisher’s exact t-test, with p-values <0.05 considered significant.
Results: Overall, we found no significant differences in demographics between patients in the 2 cohorts. Stomal stenosis occurred in 25 of 98 stomas (25.5%) after undergoing either an ACE or Mitrofanoff procedure using the historical techniques, with a median follow-up of 122.6 months for ACE cohort and 165.8 for Mitrofanoff cohort. The incidence of stomal stenosis was significantly decreased in the current technique, with one of the 31 stomas (3.2%) experiencing stenosis (p = 0.022), with a median follow-up of 78.4 months for ACE cohort, and 66.5 months for Mitrofanoff cohort. For all stomas in the current cohort there was a minimum follow-up of 4.5 years and a maximum follow-up of 7 years.
Conclusions: Our current suturing technique has significantly reduced the incidence of stomal stenosis in our patients. The technique is straightforward and flexible and can be applied to any stoma placed in any position. Only one of the patients with stomas created with the current suturing technique have developed stomal stenosis, with follow-up exceeding the median time to development of stenosis based on the historical cohort.
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