V06-12: Technique and Outcomes of Laparoscopic-Assisted Continent Cutaneous Ileocecocystoplasty
First described in 1992, the continent cutaneous ileocecocystoplasty (CCIC) involves reconfiguring the ileocecal segment for use as a bladder augment and a continent catheterizable channel (CCC). CCIC requires release of the hepatic flexure of the colon, thus a midline laparotomy must be extended far more cephalad than would be required for a standard bladder augmentation. We hypothesized that the morbidity of CCIC could be reduced by laparoscopic colon mobilization followed by a Pfannenstiel incision for completion of the procedure.
Description of the Laparoscopic-Assisted Procedure We found pure laparoscopic colon mobilization frustrating due to significant colonic distension in those with neurogenic bladder and bowel. We modified our approach to hand-assisted laparoscopic mobilization as the hand proved to be better at retracting the large colon. A 12-mm camera port is placed through the umbilicus, which later serves as the stoma site, and a 5-mm assist port is placed on the left side of the abdomen, a handbreadth cephalad to the 12-mm port. A Pfannenstiel incision is made for use as a hand port. After the colonic mobilization is completed, the remainder of the procedure is performed open through the Pfannenstiel incision. Analysis All CCIC performed at a single institution were retrospectively reviewed from 1/2012 through 12/2017. We collected demographic data, prior urologic surgery, concomitant procedures, operative time, length of hospital stay, length of follow up, and rates of 90-day complications (Clavien 2+), wound infection, channel revision, and continence. Data was analyzed using Mann-Whitney U and Fisher's exact tests.
The results are summarized (Table). There was no difference between groups with respect to age, gender, body mass index or Charleston comorbidity index. Those who underwent open procedures were more likely to have undergone prior CCC or bladder augmentation (7 vs. 1, p
Laparoscopic-assisted CCIC offers a minimally invasive alternative to open CCIC with comparable complications and long-term outcomes.