Laparoscopic-assisted continent urinary diversion in obese patients

Background and Purpose: The Pfannenstiel incision provides good access to t he bladder and bladder neck for major reconstructive surgery in the thin pa tient, whereas a midline incision is often necessary to get adequate exposu re in the obese patient, We describe our experience using laparoscopic-assi sted continent urinary diversion in conjunction with other bladder and blad der neck surgery in obese patients. Patients and Methods: Three female patients (mean age 18; mean weight 175 p ounds) with neurogenic bladder underwent Mitrofanoff appendicovesicostomy c ontinent urinary diversion to the umbilicus and pubo-vaginal sling, An umbi lical port for the telescope and two lateral ports were used. Once the appe ndix and right hemicolon had been completely mobilized up to the hepatic fl exure, reconstruction was completed through a low Pfannenstiel incision. Results: There were no laparoscopic complications. None of the laparoscopic port sites was visible postoperatively, as one was in the base of the umbi licus, and the other two had been incorporated into the Pfannenstiel incisi on. With a mean follow-up of 1 year, all patients were continent and cathet erizing their umbilicus easily. Pfannenstiel incisions were well healed, an d the patients were quite satisfied,vith their cosmesis. Conclusion: Laparoscopic-assisted Mitrofanoff appendicovesicostomy continen t urinary diversion to the umbilicus can be performed in conjunction with a Pfannenstiel incision to complete major bladder and bladder neck surgery i n the obese patient with good postoperative cosmesis, This procedure repres ents a nice compromise between a very lengthy bladder reconstructive proced ure done purely laparoscopically and a midline incision with good exposure but suboptimal cosmesis.