Split-appendix technique for simultaneous appendicovesicostomy and appendicocecostomy.
OBJECTIVE
Surgical treatment of urinary and fecal incontinence with appendicocecostomy (AC) and appendicovesicostomy (AV) has high success in achieving continence. Usually, the appendix can only be used for one of these, requiring the second channel to be constructed from alternative tissue. We describe our outcomes using the split-appendix technique for simultaneous creation of AC and AV.


METHODS
We reviewed records for all patients that underwent simultaneous AC and AV from the appendix alone from 1999 to 2009. When anatomy permitted, the appendix was divided into 2. The proximal end was kept in continuity with the cecum for an AC, whereas the distal end was used for AV. The appendiceal length, continence status, and subsequent need for surgical revision were recorded.


RESULTS
Of 394 children who underwent reconstructive surgery with a Mitrofanoff channel, 43 patients (11%) used the split-appendix technique. After a mean follow-up of 40 months, 43 of 43 ACs and 41 of 43 AVs are continent. Of the 86, 16 (19%) channels created required surgical revision.


CONCLUSIONS
The channels created from split-appendix technique have outcomes and revision rates comparable with those of other described techniques. This technique is applicable to a minority of children undergoing continent reconstruction; however, it has the benefit of avoiding a bowel resection and its accompanying risks.
Division of Urology, Nationwide Children's Hospital, Columbus, OH 43205, USA. brianvanderbrink@yahoo.com
Brian A
BA
VanderBrink
Mark P
MP
Cain
Martin
M
Kaefer
Kirstan K
KK
Meldrum
Rosalia
R
Misseri
Richard C
RC
Rink
D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D001065:Appendix / Q000601:surgery*; D002431:Cecostomy / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003559:Cystostomy / Q000379:methods*; D005242:Fecal Incontinence / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D019651:Plastic Surgery Procedures / Q000379:methods; D012086:Reoperation; D016896:Treatment Outcome; D014547:Urinary Diversion / Q000379:methods; D014549:Urinary Incontinence / Q000601:surgery*; D016476:Urinary Reservoirs, Continent