The risk of stoma stenosis complications after surgery to treat certain gastrointestinal or urinary tract diseases can be significantly lowered by a new surgical procedure that preserves the blood vessels and the tip of the appendix, a UC Davis Health study has found.
The new appendicostomy procedure preserving the tip of the appendix and its vessels.
The surgery, known as an appendicostomy, uses the appendix to connect an artificial opening (stoma) in the skin of the belly button to the colon (for antegrade colonic enema- ACE Malone procedure) or to the bladder (for Mitrofanoff procedure). It allows the delivery of an enema or emptying the bladder for patients with gastrointestinal or urinary tract diseases.
After surgery, some patients may experience complications such as stoma stenosis--the constriction or narrowing of the artificial opening. Stoma stenosis brings up to 40% of appendicostomy patients back to the operating room for surgical revision.
Innovation in appendicostomy
In 2012, Eric Kurzrock, the chief of pediatric urologic surgery and professor of urology and pediatrics at UC Davis Children's Hospital, did not agree with the mechanics of the standard appendicostomy procedure, which requires removal of the appendix tip to create the stoma. He determined that making the opening in the appendix away from the tip would preserve the blood vessels and the blood supply to the stoma.
With the new procedure, the tip of the appendix is saved and used to secure the appendix to the fascia above the belly button. This step prevents tension on the stoma, especially from patients' movements during the healing phase.
Stoma stenosis after appendicostomy
In the study published in The Journal of Urology, Kurzrock compared the incidence of stoma stenosis among patients who had traditional appendicostomy with those who received appendicostomy using the new procedure. He evaluated the medical records of 123 patients who underwent appendicostomy for ACE Malone or urinary diversion.
Kurzrock found that after standard stoma surgery (93 patients), stenosis occurred in 13% of cases, most within a year of surgery. With the new stoma technique (30 patients), no appendicostomy patient had stenosis, with follow up between one and seven years.
"After reviewing many possible factors that could be associated with stenosis, it was clear that the only factor associated with this complication was the procedural completion with the standard versus new technique," Kurzrock said.
"This modification of the appendicostomy for urine diversion and ACE Malone will hopefully prevent this common complication."
Study: Kurzrock, E. A New Appendicostomy Technique to Prevent Stomal Stenosis, The Journal of Urology. DOI:10.1097/JU.0000000000000711
