title: Rapid construction of sigmoid bladder augmentation using absorbable staples: long-term results and comparison to standard colocystoplasty in children with neurogenic bladder.
abstract: OBJECTIVE
  Absorbable staples facilitate detubularization and reconfiguration of the bowel when performing augmentation colocystoplasty. We compared the outcomes of stapled sigmoid augmentation with standard sutured colocystoplasty.
  
  
  METHODS
  Between 2003 and 2011, 108 children underwent bladder augmentation at our institution. Colocystoplasty was used in 30 patients (27.8%). Medical charts of children who underwent stapled (n = 8) or sutured (n = 22) sigmoid augmentation were compared with regard to patient demographics and surgical complications, including anastomotic leak and urolithiasis.
  
  
  RESULTS
  Eight children with underwent stapled sigmoid colocystoplasty. Average age at surgery was 8 years (range 4-17 years). Time to detubularize and refashion the bowel segment prior to augmentation was consistently under 5 min. Average length of follow-up was 44 months (range 12-80 months). One patient experienced anastomotic leak. Two of eight children (25%) in the stapled anastomosis cohort developed bladder stones. Twenty-two patients underwent standard sigmoid augmentation during the same time period (average age 8.2 years; range 4-16 years). One of 22 (4.5%) experienced anastomotic leak. Seven of 22 (31.8%) developed cystolithiasis.
  
  
  CONCLUSIONS
  Complications from stapled sigmoid anastomosis are similar to those from standard colocystoplasty. Use of absorbable staples decreases operating time by avoiding bowel spatulation and suturing, and should be considered in pediatric patients undergoing colocystoplasty.
authors.affiliation: Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA. Electronic address: angarlen@gmail.com.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Arlen
authors.affiliation: Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA.
authors.forename: Laura S
authors.initials: LS
authors.lastname: Merriman
authors.affiliation: Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA.
authors.forename: James M
authors.initials: JM
authors.lastname: Elmore
authors.affiliation: Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA.
authors.forename: Edwin A
authors.initials: EA
authors.lastname: Smith
authors.affiliation: Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA. Electronic address: akirschmd@gmail.com.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Kirsch
mesh_terms: D020341:Absorbable Implants; D000293:Adolescent; D000714:Anastomosis, Surgical / Q000379:methods; D057868:Anastomotic Leak; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D012809:Colon, Sigmoid / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013536:Suture Techniques; D013537:Sutures; D013997:Time Factors; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000175:diagnosis / Q000601:surgery*; D016476:Urinary Reservoirs, Continent
keywords: Absorbable suture; Anastomotic leak; Bladder augmentation; Bladder stone; Colocystoplasty; Neurogenic bladder