Laparoscopic Mitrofanoff continent catheterisable stoma in children with spina bifida.

Abstract

Background:In 1980, Mitrofanoff described the creation of an appendicovesicostomy for continent urinary diversion. This procedure greatly facilitates clean intermittent catheterisation in patients with neurogenic bladder. The purpose of our study was to determine the clinical efficacy of the laparoscopic Mitrofanoff catheterisable stoma for children and adolescents with spina bifida.Materials and Methods:Review of hospital records revealed that 11 children with spina bifida underwent a laparoscopic Mitrofanoff procedure with at least 1-year of follow-up. A four-port transperitoneal laparoscopic approach was used to create a Mitrofanoff appendicovesicostomy. The child was followed-up in the urology clinic at 6 weeks, 3 months, 6 months, 1-year, and then semiannually after that. Questionnaires were administered to determine, from the children's perspective, the level of satisfaction with catheterisation and the psychosocial implications of catheterisation before and after the creation of the Mitrofanoff continent catheterisable stoma.Results:Of the 11 children, six were female, and five were male. The mean age at presentation to Paediatric urological services was 11 ± 3.22 years. Overall the mean operative time was 144.09 ± 17.00 min. Mean estimated blood loss was 37.36 ± 11.44 cc. None of the cases needed conversion to open. Patient satisfaction with their catheterisation was measured at 2.18 ± 0.98 preoperatively, Post-operatively, this improved to 4.27 ± 0.46. Statistical analysis using paired t-test showed significance with P < 001.Conclusions:Laparoscopic Mitrofanoff catheterisable stoma is feasible in children with spina bifida and is associated with reasonable outcome with early recovery, resumption of normal activities and excellent cosmesis.