New alternative Mitrofanoff channel based on spiral intestinal lengthening and tailoring

Raimondo M. Cervellione, Daniel Hajnal, Gabriella Varga, George Rakoczy, Rainer Kubiak, Jozsef Kaszaki, Mihaly Boros, Rachel Harwood, Alan P. Dickson, Tamas Cserni

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Abstract

Introduction The occasional lack of appendix and the increasing use of the Malone anterograde continence enema (MACE) procedure have expanded the need for alternative Mitrofanoff channels. The Monti procedure does not always provide adequate length, the anastomosis of the double Monti, and the potential kink of the Casale channel is not ideal for smooth catheterisation. We tested the concept of spiral intestinal lengthening and tailoring (SILT), we developed originally for short bowel syndrome, to create a long and straight alternative Mitrofanoff channel (Figure). Material and methods After ethical approval five mini-pigs underwent spiral intestinal lengthening and tailoring (SILT) without any previous bowel dilatation procedure. (Mean bowel width was 20.5 ± 0.57 mm). The spiral line was marked on a 6-8-cm-long ileum approximately 15 mm apart with a 60° angle to the longitudinal axis of the bowel. When the incision was completed, the mesentery was incised perpendicularly where the spiral incision line met the mesentery. The maximum length segment hanging on a single 1.5-cm-wide well-vascularised mesentery was detached. The capillary red blood cell velocity (RBCV) and perfusion rate (PR) was measured at the edges of the opened bowel strip by in vivo microscopy using orthogonal polarising spectral imaging (Cytoscan A/R, Cytometrics, Philadelphia, PA, USA). The bowel strips have been reconstructed in spiral fashion over a 12F catheter and were implanted into the bladder. Viability, patency, and microcirculation were assessed 4 weeks later. Conventional microscopy with HE staining was performed. Results The mean length of the spiral channel (100 ± 26.4 mm) was longer than could have been achieved with the double Monti or Casale procedure (4 times the bowel width). A 17% and 8.3% reduction was measured in the median values of the RBCV and the PR at the edges of the bowel strip at the primary surgery. All implanted channels remained viable, straight, patent, and easily catheterisable after 4 weeks, with full recovery of the RBCV and PR. The histology showed no necrosis or fibrosis. Conclusion The SILT concept is suitable for creating a long and straight alternative Mitrofanoff channel. Discussion However, the SILT technique has been reported to be successful in the clinical practice to tailor and lengthen dilated short bowel; in this study we first applied this technique on normal calibre intestine to create long alternative Mitrofanoff channel. The use of an animal model and the relative short-term observation are the limitations of this study. Procedure steps. 1. The spiral incision line on the ileum and incision on mesentery. 2. A segment with the mesentery in the middle disconnected (incision at the dotted lines). 3. The disconnected bowel strip hanging on the mesentery. 4. Creation of a Mitrofanoff channel in a spiral fashion above a catheter. 5. The reconstructed channel.

Original languageEnglish
Pages (from-to)131.e1-131.e5
JournalJournal of Pediatric Urology
Volume11
Issue number3
DOIs
Publication statusPublished - Jun 1 2015

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Keywords

  • Alternative Mitrofanoff
  • Spiral intestinal lengthening (SILT)
  • orthogonal polarising spectral imaging (OPS)

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Urology

Cite this

Cervellione, R. M., Hajnal, D., Varga, G., Rakoczy, G., Kubiak, R., Kaszaki, J., Boros, M., Harwood, R., Dickson, A. P., & Cserni, T. (2015). New alternative Mitrofanoff channel based on spiral intestinal lengthening and tailoring. Journal of Pediatric Urology, 11(3), 131.e1-131.e5. https://doi.org/10.1016/j.jpurol.2015.01.013