Superiority of the VQZ Over the Tubularized Skin Flap and the Umbilicus for Continent Abdominal Stoma in Children

Abstract

Stricture prevention, avoiding exposed mucosa and cosmesis are important considerations when constructing continent abdominal stomas. We analyzed our results of continent abdominal stomas using the umbilicus and 2 types of lower abdominal stomas, that is the V-quadrilateral-Z technique and the tubular skin flap. Patient charts were reviewed retrospectively. All patients with a continent abdominal stoma were included in our study. Patients were divided into 3 groups according to type of stoma, including umbilicus, tubular skin flap and V-quadrilateral-Z. The groups were compared regarding demographics, etiology, success, complications and the need for revision. A total of 40 incontinent patients were included in our study. All underwent Mitrofanoff urinary diversion (37) and/or Malone antegrade continence enema construction (13) between 1993 and 2007. The umbilicus was used for 31 conduits, the V-quadrilateral-Z was used for 8 and the tubular skin flap was used for 11. Patient age and gender, and the etiology of incontinence were similar in the 3 groups. All patients achieved good cosmesis with a hidden bowel mucosa. In the V-quadrilateral-Z group no patient had stomal stenosis. Five patients (45%) in the tubular skin flap group required dilation or revision for obstruction or stenosis, which was successful in 4. Eight umbilical conduits (25%) had to be dilated or revised due to stomal stenosis (6) and conduit obstruction (2). Initial results with the V-quadrilateral-Z flap show its superiority over the tubular skin flap and the umbilicus for stomal construction in patients with a Mitrofanoff or Malone antegrade continence enema conduit.