After appendicostomy for laparoscopic ACE Malone or Mitrofanoff, stomal stenosis has been reported to occur in 12% to 45% of patients.  The objective of this investigation is to analyze outcomes after the utilization of a novel stoma technique that preserves the appendiceal tip and vessels and opens the lumen in a more proximal and vascular area to improve perfusion and decrease stenosis.

Medical records of patients who underwent the novel stoma technique during ACE or urinary diversion were retrospectively evaluated. Variables such as open or laparoscopic approach, age, gender, body mass index, antegrade continence enema or urinary diversion, cecal and appendiceal adhesions, retrocecal position, cecal imbrication, technique, frequency of catheterization and stenosis were recorded. Stenosis is defined by need for revision surgery and/or indwelling catheter for any length of time. Cox proportional hazards analyses were performed to determine association of covariates.

A total of 44 patients met inclusion criteria with a median age of 9.0 years. The appendix was imbricated in 10% of ACE procedures and all continent diversions. No patient has developed stomal stenosis or obstruction after a median follow up of 4.8 years (range 1 to 10 years). There was no association of stenosis with any variable including surgical approach, laparoscopic or open.

Stomal stenosis after appendicostomy is lessened by preservation of the distal appendiceal vasculature and tip and opening the lumen in a more proximal location.

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Continence 12S (2024) 101397
DOI: 10.1016/j.cont.2024.101397