A modified Mitrofanoff procedure using the rectus abdominis muscle flap technique: A preliminary report in a rabbit model

Abstract

Objective: To create a modified Mitrofanoff continent stoma in a rabbit model, using a rectus abdominis muscle flap (RAMF) with its intact vascular supply. Materials and methods: Fifteen New Zealand White male rabbits underwent an operation to create a 6 cm long tube using a RAMF with its vascular pedicle from the inferior epigastric vessels. The internal orifice of the tube was anastomosed to the anterior bladder wall with 5/0 polyglactin sutures. The external orifice was directly sutured to the skin to fashion a catheterizable Mitrofanoff stoma. A 6 F catheter was left in the tube as a stent for 2 weeks. Radiography and histopathological investigations were carried out for 8 weeks after surgery. Results: Intravenous pyelography and voiding cystourethrography showed a normal looking urinary system; contrast studies showed an intact RAMF tube with no signs of stricture. Catheterization of the stoma was possible in each animal. Histopathologically, there was no evidence of severe fibrosis or inflammatory changes: the inner surface of the tube (proximal bladder side) was covered by transitional urinary epithelium in most of the animals. Conclusion: It is possible to create a Mitrofanoff tube using a vascularized RAMF in a rabbit model. Using this technique there is no need to perform a major operation in the gastrointestinal system. The technique may provide a good alternative treatment in those patients who need a combination of Mitrofanoff and antegrade continence enema surgery, and in patients with previous appendectomy.