Perimesenteric detubularization of ileum for ileocystoplasty improves compliance and increases capacity

Objective To describe a modified form of detubularization using a perimesen teric incision of the ileal segment, which increases the capacity of the ne obladder and reduces the length of the ileal segment required. Patients and methods From February 1993 to November 1999, ileocystoplasty w as undertaken in 20 patients (mean age 8.4 years, range 4-16). Six had myel odysplasia, four had primary epispadias, five had bladder exstrophy, three had post-traumatic lesions and two had cloacal exstrophy. The patients were divided into two groups; in the first (eight patients, mean age 9.6 years, range 5-15) the ileal segment was opened along the antemesenteric border a nd in the second (12 patients, mean age 7.7 years, range 4-16) the ileal se gment was opened adjacent to the mesentery, perimesenterically. Each segmen t was then folded and the perimesenteric edges sutured to form the pouch. Results The patients were assessed at 1 year after surgery; the neobladder capacity was evaluated as ((neobladder capacity-bladder capacity)/body weig ht), which shows the relative increase of bladder capacity after enterocyst oplasty per unit of weight. There was a statistically significant increase in neobladder capacity in group 2 (perimesenteric transection; Kruskal-Wall is chi-square, P = 0.005: Mann-Whitney U-test, P = 0.006). Conclusion These results indicate that augmentation can be carried out by p erimesenteric transection of the intestinal segment, which improves complia nce and increases capacity of the neobladder.