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Outcomes of Mitrofanoff Surgical Revision
Christopher Bean, MD, Brian VanderBrink, MD, Eugene Minevich, MD, Shumyle Alam, MD, William Defoor, MD, Pramod Reddy, MD.
Cincinnati Children's, Cincinnati, OH, USA.
BACKGROUND: Continent catheterizable channels (CCC) for bladder emptying using the Mitrofanoff procedure are frequently performed for patients undergoing continent urinary. Complications associated with these channels occur and may require surgical revision. While the knowledge of the possibility for surgical revision of the Mitrofanoff exists, the outcomes of such revisions have not been well described in the literature. We describe our clinical experience following surgical Mitrofanoff revisions.
METHODS: A retrospective chart review was performed on patients undergoing Mitrofanoff revision at our institution between 2001 and 2011. Clinical variables recorded were patient age, type of Mitrofanoff (appendiceal, reconfigured bowel or ureter), location of stoma, time from creation of Mitrofanoff to revision, indication for revision, level of revision (skin level, subfascial), length of follow up, and need for repeat intervention.
RESULTS: A total of 151 Mitrofanoff CCCs (88 appendix, 61 Monti, 2 ureteral) were created at our institution during the study period with 49 Mitrofanoff revisions performed at same time interval in 40 patients. Four patients’ CCC were created at an outside institution while the remainder had their Mitrofanoff created by our Division using an extravesical implantation technique. Mean time to revision was 44 months (3 to 240 months) and length of follow-up of the cohort was 47 months (3 to 140 months). Mitrofanoffs requiring revision consisted of appendix in 24 (49%), reconfigured bowel in 23 (47%), and ureter in 2 (4%). Stomal location was in the right lower quadrant in 41 (84%), umbilicus in 6 (12%), and left lower quadrant in 2 (4%). Indication for revision consisted of stomal stenosis (SS,n=32, 67%), stomal incontinence (n=4, 9%), mucosal prolapse (n=3, 6%), false passage (FP,n=3, 6%), intraluminal stenosis (n=2, 4%), combination SS/SP (n=2, 4%), and stomal relocation during additional reconstruction (n=2, 4%). The level of Mitrofanoff revision was at the skin in 31 (64%), fascial in 10 (20%), and bladder level in 8(16%) cases.
Thirty-three patients (82.5%) had their complication successfully treated with a single operation. Seven patients required 2 revisions (6 for SS and 1 for intraluminal stricture) while one patient required 3 revisions SS/FP. Revision failures occurred in 2 patients after revision for SS/FP - one patient was lost to follow up after 1 revision and another patient went for a second opinion after 2 revisions. The overall success rate of Mitrofanoff revisions was 95%.
CONCLUSIONS: Mitrofanoff revisions were necessary in 24% of patients undergoing Mitrofanoffs at our institution. Patients that did require a surgical revision of their Mitrofanoff experienced a 95% success rate in resolving the issue. 82.5% of this cohort had their issue resolved with a single procedure without recurrence. The majority of these CCC revisions occurred as an outpatient and without need for laparotomy.
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