Split Appendix Malone and Mitrofanoff for the Management of Neurogenic Bowel and Bladder

Abstract

Purpose: To share our experience of neurogenic bowel and bladder management by creating Malone Antegrade Continent Enema (MACE) procedure and Continent Urinary Diversion (Mitrofanoff VQZ technique) at the same time by using split appendix. Material and Methods: Between July 2017 and December 2021, 30 patients; 5 to 15 years old (mean 9.54±2.65 years) underwent VQZ Mitrofanoff and MACE using split appendix with or without bladder augmentation forneurogenic bladder and bowel management secondary to myelomeningocele. Proximal part of appendix was used for MACE by taking 3 antireflux stitches by wrapping seromuscular layer of cecum around base of appendix whereas distal part of appendix is used for Mitrofanoff creating VQZ stoma. The average length of appendix taken was 9.5 cm (8-12 cm). Results: All the patients were kept clean and dry throughout and were followed up for an average of 15 months (12 to 30 months). Only one patient was reported with MACE stoma stenosis because she lost to follow up and didn’t use the stoma for a year, stoma revision was performed on her. Procedure time is also reduced in split appendix MACE and Mitrofanoff as compared to if monti tube or cecal flap is reconstructed for MACE. Conclusion: MACE and Mitrofanoff with or without bladder augmentation are very invaluable procedures for the management of neurogenic bowel and bladder. Split appendix is an ideal channel for both Mitrofanoff and MACE.