title: Bladder augmentation with an omental pedicled gastric seromuscular flap without the necessity of gastric resection.
abstract: Bladder augmentation using gastrointestinal segments requires gastric or intestinal resection. This has several risks. In a rat model, we aimed to test the efficacy of a new procedure in which a gastric seromuscular (GSM) flap is separated from the gastric mucosa without the necessity of gastric resection, and this GSM flap, based on an omentum pedicle, is transferred to the bladder. A GSM flap based on an omental leaf was dissected from the gastric mucosa and rotated 180 degrees counter-clockwise, after ligation of the vessels relating to the omentum, until the mid-duodenum. After urodynamic analysis for control levels of bladder capacity and pressure, the GSM flap was anastomosed to the bladder with a continuous suture. Because four rats died due to bladder calculi, only 21 of 25 rats were killed at 1 month (n = 10) and 4 months (n = 11) for histopathological and urodynamic evaluations of the augmented bladder. Bladder capacity increased significantly in the augmented bladders compared to preaugmentation (P < 0.001). There was no significant difference between end-filling pressures of the augmented bladders and preaugmentation. Histopathological findings demonstrated that the muscular surface of the flap was completely re-epithelialized in all rats. Squamous metaplasia was detected in 30% (3/10) of the 1 month group rats, and in 55% (6/11) of 4 month rats (P > 0.05). Gross calculi formation appeared in 20% (2/10) of the 1 month group rats, and in 34% (4/11) of 4 month rats (P > 0.05). Our data show that the use of the GSM flap in the bladder of a rat resulted in the complete re-epithelialization of the flap and sufficient bladder capacity. Despite significant complications such as death, metaplasia and calculi, this technique may be considered as an alternative experimental model to traditional full-thickness patching, which needs gastric or intestinal resection.
authors.affiliation: Department of Pediatric Surgery, Akdeniz University School of Medicine, 07070 Antalya, Turkey, adnanaslan@akdeniz.edu.tr
authors.forename: Adnan
authors.initials: A
authors.lastname: Aslan
authors.forename: Bahar
authors.initials: B
authors.lastname: Akkaya
authors.forename: Güngör
authors.initials: G
authors.lastname: Karagüzel
authors.forename: Gülten
authors.initials: G
authors.lastname: Karpuzoglu
authors.forename: Mustafa
authors.initials: M
authors.lastname: Melikoglu
mesh_terms: D000818:Animals; D001707:Biopsy, Needle; D004195:Disease Models, Animal; D005260:Female; D005753:Gastric Mucosa / Q000637:transplantation*; D007150:Immunohistochemistry; D009852:Omentum / Q000637:transplantation*; D011336:Probability; D051381:Rats; D011919:Rats, Inbred Strains; D019651:Plastic Surgery Procedures / Q000379:methods; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013524:Surgical Flaps; D015996:Survival Rate; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods; D019459:Urothelium / Q000473:pathology