Robotic-assisted laparoscopic Malone appendicostomy: a 6-year perspective

被引:2
|
作者
Ostertag-Hill, Claire A. [1 ]
Nandivada, Prathima [1 ]
Thaker, Hatim [2 ]
Estrada, Carlos R. [2 ]
Dickie, Belinda H. [1 ]
机构
[1] Boston Childrens Hosp, Dept Surg, 300 Longwood Ave Fegan 3, Boston, MA 02115 USA
[2] Boston Childrens Hosp, Dept Urol, 300 Longwood Ave, Boston, MA 02115 USA
关键词
Robotic-assisted surgery; Appendicostomy; Neoappendicostomy; Antegrade continence enema; Appendicovesicostomy; FECAL INCONTINENCE; CHILDHOOD CONSTIPATION; MANAGEMENT; APPENDICOVESICOSTOMY; CHILDREN; BLADDER; IMPACT;
D O I
10.1007/s00383-024-05641-z
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Purpose: A robotic-assisted laparoscopic approach to appendicostomy offers the benefits of a minimally invasive approach to patients who would typically necessitate an open procedure, those with a larger body habitus, and those requiring combined complex colorectal and urologic reconstructive procedures. We present our experience performing robotic-assisted appendicostomies with a focus on patient selection, perioperative factors, and functional outcomes. Methods: A retrospective review of patients who underwent a robotic-assisted appendicostomy/neoappendicostomy at our institution was performed. Results: Twelve patients underwent robotic-assisted appendicostomy (n = 8) and neoappendicostomy (n = 4) at a range of 8.8-25.8 years. Five patients had a weight percentile > 50% for their age. Seven patients underwent combined procedures. Median operative time for appendicostomy/neoappendicostomy only was 185.0 min. Complications included surgical site infection (n = 3), stricture requiring minor operative revision (n = 2), conversion to an open procedure due to inadequate appendiceal length (prior to developing our technique for robotic neoappendicostomies; n = 1), and granuloma (n = 1). At a median follow-up of 10.8 months (range 1.7-74.3 months), 91.7% of patients were consistently clean with antegrade enemas. Discussion: Robotic-assisted laparoscopic appendicostomy and neoappendicostomy with cecal flap is a safe and effective operative approach. A robotic approach can potentially overcome the technical difficulties encountered in obese patients and can aid in patients requiring both a Malone and a Mitrofanoff in a single, combined minimally invasive procedure.
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页数:6
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