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Simultaneous Placement of Fecal and Urinary Continent Channel Stomas In The Umbilicus: Single-Center Experience
Raquel Quintanilla, MD1, Cinthia S. Galvez, MD2, Daniel Nassau, MD1, Maria Camila Suarez, MD1, Yisel Babastro, MD1, Andrew Ransford, MD1, Miguel Castellan, MD1, Alireza Alam, MD1, Rafael Gosalbez, MD1.
1Nicklaus Children's Hospital, Miami, FL, USA, 2Jackson Memorial Hospital, Miami, FL, USA.

Abstract
Background Patients with neurogenic disorders frequently experience bladder and bowel dysfunction. The urinary continent channel (UCC) technique originally described by Mitrofanoff in 1980 as well as the Malone antegrade continent enema (MACE) procedure reported by Malone 10 years later, offers the possibility achieving social urinary and fecal continence. In both cases, the stoma was placed in the right lower quadrant. Subsequently the umbilicus became the preferred site for single channel stomas given the ability to conceal the stoma. However, there are no studies describing outcomes of both stomas being created in the umbilicus. We aimed to describe our experience in patients who underwent UCC and MACE stomas both placed concurrently in the umbilicus.
Methods A retrospective review from 2009 to 2020 was performed in our institution for patients who underwent the creation of UCC and MACE stomas simultaneously in the umbilicus. The variation in the technique involves two V-skin shaped flaps in the umbilicus; the MACE and UCC stomas are delivered from both flaps and placed at the right and left side respectively. Figure 01 Patients with greater than 3 months of follow-up were included in the study. Figure 02
Results There were 17 consecutive patients identified with the median age of 13.5 years and a median follow-up of 41.4 months. The mean BMI percentile was 89.5%. The split appendix technique was utilized in 9 (53%) patients and 13 (76.5%) patients required concurrent urological procedures. All channel-related complications occurred within a mean time of 15.6 months. Skin-level stenosis in the MACE occurred in 4 (23.5%) patients and all were successfully managed by placing an indwelling catheter for up to two weeks. There were 2 (11.8%) complications related to UCC, which required subfascial minor surgical revision. The rate of patients with symptomatic UTI decreased 35.3% postoperatively and no new onset of UTI occurred in patients without a prior history of UTI. During follow-up, 16 (94%) patients remained totally dry between CIC and one had occasional leakage related to delay in timely catheterization. Total fecal continence was achieved in 14 (82.3%) patients with a MACE. Additionally, 3 (16.6%) patients experienced improvement in fecal continence with sporadic soiling episodes.
ConclusionsPlacement of UCC and MACE stomas in the umbilicus demonstrate an overall complication rate of 6 (35.3%) with only 2 patients requiring surgical intervention, comparable to the standard. UTI rate decreased in patients with a prior history of UTI. Simultaneous UCC and MACE stomas placed at the umbilicus showed good functional outcomes and similar complication rates to traditional approach where stomas were placed separately in the abdominal wall.


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