title: Superiority of the VQZ over the tubularized skin flap and the umbilicus for continent abdominal stoma in children.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors: Pediatric Urology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel. hezil@cc.huji.ac.il
authors: Ezekiel H
authors: EH
authors: Landau
authors: Ofer N
authors: ON
authors: Gofrit
authors: Helio
authors: H
authors: Cipele
authors: Benjamin
authors: B
authors: Hardak
authors: Mordechai
authors: M
authors: Duvdevani
authors: Dov
authors: D
authors: Pode
authors: Ofer Z
authors: OZ
authors: Shenfeld
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013524:Surgical Flaps; D054047:Surgical Stomas; D014472:Umbilicus; D014547:Urinary Diversion / Q000379:methods; D013520:Urologic Surgical Procedures / Q000009:adverse effects