Abstract
We developed an experimental ex-vivo model to define factors that may influence continence of catheterizable channels by urinary and colonic stomas based on the principle of imbrication of the outlet tube. From 20 pigs, colon specimens with 25 cm length were obtained and a transverse flap with 3.0 cm length x 1.5 cm width in the average point of the intestine was tubulated to create an efferent tube. With the tube configured, it was embedded by 3 seromuscular stitches far 0.5 cm each other. A pressure study of both intra-luminal surface and channel was then conducted during the filling of the submerse piece with environmental air in a water container, to define the efferent channel continence. The study was repeated after the progressive release of suture stitches until only one stitch remains. Channel continence analyzed in each segment in three different valve length situations, making a total of 20 segments, revealed that with 3 stitches (1.5 cm valve) the maximum average pressure prior to overflow was 54 cm H2O; 53.65 cm H2O with 2 stitches (1.0 cm of valve), and 55.45 cm H2O with only one stitch (0.5 cm of valve), which are the same values. The record at the segment explosion pressure was 67.87 cm H20. The study showed that angulation of channel with colon, maintained by only one stitch (0.5 cm imbrication) was more important than a larger extension of the valve, represented by 3 suture stitches (1.5 cm imbrication) in order to allow continence to the efferent channel.
Highlights
Mitrofanoff’s principle is regarded as a routine procedure in pediatric urology and the appendix is the channel of choice for that purpose [1] being Monti’s tubes a valid alternative [2].Recently, our group published a technique of ileal catheterizable reservoir for bladder reconstruction, discharging the use of both appendix and Monti’s tube, thereby simplifying the surgery strategy [3]
The study showed that angulation of channel with colon, maintained by only one stitch (0.5 cm imbrication) was more important than a larger extension of the valve, represented by 3 suture stitches (1.5 cm imbrication) in order to allow continence to the efferent channel
In order to understand best the functioning of this method of continence used in the above-mentioned techniques and attribute the importance of the extension of the necessary imbrication to produce continence, we developed an ex-vivo model in pig’s colon segments with efferent channel under valve, aiming to check channel’s continence by means of a pressure study [6]
Summary
Mitrofanoff’s principle is regarded as a routine procedure in pediatric urology and the appendix is the channel of choice for that purpose [1] being Monti’s tubes a valid alternative [2].Recently, our group published a technique of ileal catheterizable reservoir for bladder reconstruction, discharging the use of both appendix and Monti’s tube, thereby simplifying the surgery strategy [3]. Mitrofanoff’s principle is regarded as a routine procedure in pediatric urology and the appendix is the channel of choice for that purpose [1] being Monti’s tubes a valid alternative [2]. Thereafter, the same principle has been applied to the left colon aiming to provide an ostomy for antegrade enemas in severe fecal incontinence as an alternative to MACE [4,5]. In both techniques, channel’s continence mechanism is represented by imbrication of the efferent channel over seromuscular stitches either at the top of reservoir or at the colon. In order to understand best the functioning of this method of continence used in the above-mentioned techniques and attribute the importance of the extension of the necessary imbrication to produce continence, we developed an ex-vivo model in pig’s colon segments with efferent channel under valve, aiming to check channel’s continence by means of a pressure study [6]
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