WOFAPS 2025 8th World Congress of Pediatric Surgery

Johana Paez, Daniela Moreno Villamizar, Camilo Orjuela, Yair Cadena

La Cardio Hospital, Colombia

Purpose: To present the laparoscopic Mitrofanoff procedure in a pediatric patient with an acontractile detrusor and a history of bilateral ureteral reimplantation for severe vesicoureteral reflux and posterior urethral valves.

Video method: We present the step-by-step laparoscopic Mitrofanoff procedure in a pediatric patient. Three ports are used: a 12 mm telescope port in the left subcostal area, and two 5 mm ports in the right subcostal region and left flank. The appendix is harvested with careful preservation of its blood supply and is ligated at the base using gold Hem-o-lock clips. The tip is excised, and the appendix is spatulated.

Bladder exposure is achieved using 5-0 Prolene traction stitches. A posterior detrusotomy is performed using monopolar energy. A 1 cm longitudinal incision is made in the bladder mucosa at the apex. Through this, 1 to 1.5 cm of the spatulated appendix is introduced to create a valve-like mechanism.

A running anastomosis is performed between the serosa of the appendix and the bladder mucosa using 5-0 PDS sutures. The distal appendix is catheterized with an 8 Fr Nelaton tube. The detrusor muscle is closed over the reimplanted appendix with interrupted 4-0 Caprofyl sutures, creating a submucosal tunnel. The appendix is brought up to the umbilicus, and the appendicocutaneous anastomosis is completed with 6-0 PDS sutures to form the Mitrofanoff stoma.

Results: The child began oral liquids 6 hours post-procedure. Antibiotics were administered at therapeutic doses for one week, then continued at prophylactic doses for four weeks. The urethral catheter was removed after 15 days, and the Mitrofanoff catheter at 4 weeks, once the parents were comfortable performing catheterization through the stoma

Conclusions: This laparoscopic approach combines the benefits of minimal invasiveness with excellent functional outcomes