IN-SITU TUNNELED BOWEL FLAP TUBES - 2 NEW TECHNIQUES OF A CONTINENT OUTLET FOR MAINZ POUCH CUTANEOUS DIVERSION

In Mainz pouch continent cutaneous urinary diversion, introduction of the in situ tunneled appendix as the continent outlet in 1990 has simp lified the surgical technique and greatly increased the acceptance of the procedure. Based on the results of long-term animal studies, 2 new techniques of a continent outlet were randomly used with a Mainz pouc h 1 procedure (ileocecal pouch) in 17 patients in whom the appendix wa s not available or usable for construction of a continent outlet. Acco rding to the flap valve principle of the tunneled appendix, in 17 pati ents a small caliber conduit was created from large bowel wall at the lower pole of the cecum and was tunneled in situ under the mucosa. In technique 1 (seromuscular bowel flap tube), a tube lined by serosa was created from a pedicled island flap of large bowel wall in 11 patient s. In technique 2 (full thickness bowel flap tube), a tube lined by mu cosa was created from a pedicled flap of large bowel wall in 6 patient s. After a mean followup of 8 months (range 2 to 17) 16 of 17 patients catheterize the reservoir at intervals of 4 to more than 6 hours usin g 14 to 16F catheters and are continent day and night without leakage. The only major complication in this series was incontinence in 1 pati ent with a seromuscular bowel flap tube who died of metastatic tumor 6 months postoperatively.