Pediatric Urology, Section of Urology, Comer Children's Hospital, The University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA.
BJU Int. 2012 Jan;109(1):125-9. doi: 10.1111/j.1464-410X.2011.10317.x. Epub 2011 Jul 28.
To evaluate the feasibility and report our initial experience with Robotic-Assisted Laparoscopic Mitrofanoff Appendicovesicostomy (RALMA) in patients with prune belly syndrome. The Mitrofanoff appendicovesicostomy procedure uses the appendix to create an easily accessible continent, catheterizable channel into the urinary bladder. Historically, the procedure is performed by an open surgical approach in prune belly patients. We describe our initial experience herein.
Between October 2008 and February 2010 three patients with prune belly syndrome underwent RALMA. The appendicovesicostomy anastomosis was performed on the anterior bladder wall and the stoma was brought to the umbilical site or right lower quadrant. At least 4 cm of detrusor backing was ensured. The appendicovesicostomy stent was left in place for 4 weeks postoperatively before initiation of catheterization.
Mean age at surgery was 9.7 years (range 5-14 years). Blood loss volume was 20 mL in each case. Overall mean operative time was 352 min (range 319-402 min). There were no intraoperative complications and no open conversions. There was one postoperative complication in the form of wound infection. All patients are catheterizing their stomas and are continent at an average follow-up of 14.7 months (range 5-21 months).
In our initial experience, RALMA is a feasible option with encouraging early experience for creating a continent catheterizable channel into the urinary bladder in patients with prune belly syndrome.
评估机器人辅助腹腔镜下米托法诺夫阑尾膀胱吻合术（RALMA）在脐膨出患者中的可行性，并报告我们的初步经验。米托法诺夫阑尾膀胱吻合术使用阑尾在膀胱内建立一个易于接近的、可控的通道。历史上，这种手术在脐膨出患者中是通过开放手术进行的。我们在此描述我们的初步经验。
2008 年 10 月至 2010 年 2 月，3 例脐膨出患者接受了 RALMA。阑尾膀胱吻合术在前膀胱壁上进行，造口被带到脐部或右下象限。确保至少有 4cm 的逼尿肌支持。术后至少 4 周内留置阑尾膀胱吻合术支架，然后开始导尿。
手术时的平均年龄为 9.7 岁（范围 5-14 岁）。每个病例的失血量为 20ml。总的平均手术时间为 352 分钟（范围 319-402 分钟）。无术中并发症，无开放转换。有 1 例术后并发症为伤口感染。所有患者都在进行造口导尿，在平均 14.7 个月（范围 5-21 个月）的随访中都保持尿控。
在我们的初步经验中，RALMA 是一种可行的选择，为脐膨出患者在膀胱内建立可控的导尿通道提供了令人鼓舞的早期经验。
