V12-14 SYNCHRONOUS PANNICULECTOMY AND ILEAL CONDUIT REVISION FOR OBESE PATIENTS WITH STOMAL STENOSIS

Abstract

You have accessJournal of UrologyReconstruction1 Apr 2015V12-14 SYNCHRONOUS PANNICULECTOMY AND ILEAL CONDUIT REVISION FOR OBESE PATIENTS WITH STOMAL STENOSIS Michael Garcia-Roig, David Pan, Devendar Katkoori, and Murugesan Manoharan Michael Garcia-RoigMichael Garcia-Roig More articles by this author , David PanDavid Pan More articles by this author , Devendar KatkooriDevendar Katkoori More articles by this author , and Murugesan ManoharanMurugesan Manoharan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2784AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radical cystectomy with ileal conduit urinary diversion is a common procedure for muscle invasive bladder cancer. With the rise in obesity, surgeons more frequently face obesity-related challenges in perioperative management. Specific to ileal conduit diversion, obese patients with abnormal skin folds may develop stomal retraction or stenosis. This results in a poorly fitting appliance followed by urinary leakage and skin excoriation. Here we describe our technique for synchronous panniculectomy and ileal conduit revision in such patients. METHODS After routine prepping and position of the patient, the stoma and umbilicous are mobilized. Then, a transverse elliptical incision is made and the panus is excised above the anterior rectus sheath. The lateral limit of the ellipse is the anterior axillary line bilaterally and a vertical distance between the top and bottom of the ellipse is 8-15 cm, depending on the patient's body habitus. The upper flap is mobilized allowing for a tension free re-approximation. The neo-stoma and neo-umbilicus sites are marked and created on the upper flap and the upper flap is sutured to the lower flap. RESULTS Panniculectomy with stomal revision was performed for four female patients who presented with stomal stenosis and a mean BMI of 42 (38-49) kg/m3. Follow-up ranged from 2-5 yrs with patients reporting improved fit of the stoma appliance and no recurrent stomal complications. There were no postoperative complications related to the procedure. CONCLUSIONS The main advantage of this approach is in reducing excessive peri-stomal fat that leads to uneven skin and thus urostomy leakage. Furthermore, it avoids a laparotomy in a surgically unfavorable patient population. Our technique of panniculectomy and stomal revision is safe and carries minimal morbidity. It may improve nursing care and quality of life for obese patients with urinary diversion and stomal retraction. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e981 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Garcia-Roig More articles by this author David Pan More articles by this author Devendar Katkoori More articles by this author Murugesan Manoharan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...