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11–14 APRIL, 2018, HELSINKI, FINLAND
13:19–13:24
S26-7 (VP)
LARPAROSCOPIC POSTERIOR APPENDIX MITROFANOFF
UTILISING THE MODIFIED SHANFIELD ANASTOMOSIS
Eleni PAPAGEORGIOU and Abraham CHERIAN
Great Ormond Street Hospital for Children Nhs Foundation Trust, Department of Paediatric Urology, London,
UNITED KINGDOM
PURPOSE
The formation of an appendix Mitrofanoff-channel is an established continent urinary conduit to
achieve bladder emptying. In this video we present the laparoscopic technique for appendico-
vesicostomy, using trans-umbilical approach, 3 mm instruments, two working ports, and a modified
Shanfield anastomosis.
MATERIAL AND METHODS
A 5-year old boy with large residuals and hematuria was diagnosed as non-neurogenic neurogenic
bladder and was suitable for a Mitrofanoff-channel formation.
Technique: The procedure is performed using a transperitoneal three-port approach. A 30-degree
camera is inserted through a 5 mm trans-umbilical port. Two 3 mm working ports are triangulated to
achieve optimal access to the appendix and bladder. The caecum is mobilised adequately.Atransab-
dominal 2/0 PDS hitch stitch elevates the bladder. Posterior detrusorotomy and submucosal dissec-
tion follows. The appendix is detached from the colon preserving its pedicle. The proximal appendix
is spatulated for 5 mm, pulled through a hiatus created in the distal vesical mucosa into the bladder
using a U-stitch and fixed. Three additional stitches between the bladder mucosa and the appendix
serosa secure the anastomosis. Closing the detrusor muscle, with a 10Fr Jacques catheter in the
conduit, creates an anti-refluxing extra-mucosal tunnel. The tip of the appendix is brought out to the
right iliac fossa and a VQ-plasty is fashioned.
RESULTS
The procedure was completed in 4 hours. Postoperative analgesia was provided with Fentanyl-
NCA up to post-op day-4, paracetamol and oxybutynin. Oral intake was established on day-1 and
the patient was discharged on day-5 without any complications.
CONCLUSIONS
The laparoscopic appendico-vesicostomy can be facilitated with minimal number of ports and the
transumbilical approach utilises a natural scar. The anastomosis is simplified and the catheterisa-
tion is reliable as there is no mucosa-mucosa junction to negotiate.
13:24–13:36
Discussion