WOFAPS 2025 8th World Congress of Pediatric Surgery

Malek Mezni, Yosra Ben Ahmed, wiem Hamouda, Mariem Marzouki, Faouzi Nouira, Said Jlidi

Children Hospital Bechir Hamza, Pediatric surgery department B. Tunis, Tunisia

Background
The Mitrofanoff procedure offers a continent catheterizable channel for bladder emptying in children with impaired bladder function. This study aims to evaluate the indications, surgical outcomes, and long-term complications associated with this technique in a pediatric population from a resource-limited country.

Methods
We conducted a retrospective, single-center study of children who underwent the Mitrofanoff procedure between 2004 and 2024, with regular follow-up in our pediatric surgery department.

Results
Eighteen children (10 males, 8 females) were included, with a mean follow-up of 6 years. The mean age at surgery was 9 years (range: 5–15). Indications included neurogenic bladder in 9 patients (6 with myelomeningocele, 3 with sacral agenesis), bladder exstrophy in 8, and posterior urethral valves in 1. All patients underwent appendicovesicostomy in 3 cases and in combination with other reconstructive surgeries in the remaining cases.

Postoperative complications were observed in 72% of patients. The most common was stomal stenosis (39%), with a median onset within the first year post-surgery. All patients with complications required at least one surgical revision, with an average of 2 reinterventions per patient (range: 1–7). Among them, 31% were treated by cutaneous revisions. In 38% of complicated cases, the conduit was ultimately abandoned due to poor tolerance or parental refusal.

Conclusions
The Mitrofanoff procedure remains a valuable solution for achieving continence in children with complex bladder dysfunction. However, the high rate of complications and reoperations highlights the need for meticulous patient selection, comprehensive preoperative counselling and structured long-term follow-up.