V12-14: Synchronous Panniculectomy And Ileal Conduit Revision For Obese Patients With Stomal Stenosis

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Introductions and Objectives
Radical cystectomy with ileal conduit urinary diversion is a common procedure for muscle invasive bladder cancer. With the rise in obesity, surgeons more frequently face obesity-related challenges in perioperative management. Specific to ileal conduit diversion, obese patients with abnormal skin folds may develop stomal retraction or stenosis. This results in a poorly fitting appliance followed by urinary leakage and skin excoriation. Here we describe our technique for synchronous panniculectomy and ileal conduit revision in such patients.

Methods
After routine prepping and position of the patient, the stoma and umbilicous are mobilized. Then, a transverse elliptical incision is made and the panus is excised above the anterior rectus sheath. The lateral limit of the ellipse is the anterior axillary line bilaterally and a vertical distance between the top and bottom of the ellipse is 8-15 cm, depending on the patient’s body habitus. The upper flap is mobilized allowing for a tension free re-approximation. The neo-stoma and neo-umbilicus sites are marked and created on the upper flap and the upper flap is sutured to the lower flap.

Results
Panniculectomy with stomal revision was performed for four female patients who presented with stomal stenosis and a mean BMI of 42 (38-49) kg/m3. Follow-up ranged from 2-5 yrs with patients reporting improved fit of the stoma appliance and no recurrent stomal complications. There were no postoperative complications related to the procedure.

Conclusions
The main advantage of this approach is in reducing excessive peri-stomal fat that leads to uneven skin and thus urostomy leakage. Furthermore, it avoids a laparotomy in a surgically unfavorable patient population. Our technique of panniculectomy and stomal revision is safe and carries minimal morbidity. It may improve nursing care and quality of life for obese patients with urinary diversion and stomal retraction.

Funding: none