Abdominoplasty successful for revising complicated urostomies
MedWire News: UK researchers have developed a novel surgical technique, uro-abdominoplasty, for revision of complicated urostomies.
"Our study is the first to describe the successful use of abdominoplasty to revise complicated urostomies, providing both functional and aesthetic benefits," write Zita Mickute (University of Cambridge) and team in the Annals of Plastic Surgery.
They explain that attempts to minimize urostomy complications rely largely on the initial preoperative siting of the stoma, avoiding abdominal folds and creases, as well as ensuring stomas are of adequate length.
"Only a minority of patients continue to experience problems with appliance fitting despite maximal conservative measures and minor revision surgeries, usually due to the lack of flat surface on the abdomen," they say. "It is this challenging group of patients that may benefit from referral to the Plastic Surgery Service."
Mickute et al identified four patients with an average body mass index of 32 kg/m2 and a mean age of 56 years who underwent uro-abdominoplasty to revise their complicated urostomies between December 2007 and December 2009. Ileal conduits had been performed following ablative or diversion surgery for cervical carcinoma, interstitial cystitis, or neuropathic bladder.
A postal questionnaire was used to establish pre- and postabdominoplasty stoma function.
Preoperatively, all patients experienced problems with urostomy appliance fitting, leading to urinary leakage of at least once a day (mean of 9 times per week). Two patients reported skin irritation and three admitted that their urostomy problems caused social embarrassment. All four patients needed to change their appliance more than once a day on average.
Specific indications for plastic surgical intervention included abdominal scars (n=4), large abdominal apron (n=4), deep skin folds (n=2), and urostomy retraction (n=2).
The operation lasted a mean or 3 hours and patients were discharged from hospital a median of 8 days postoperatively.
The authors report that the technique reduced the frequency of urinary leakage by over 50%, which resulted in a subjective overall improvement in quality of life (n=3). The length of time patients were able to maintain the urostomy appliance before needing to change it was also increased. However, the team notes that leakage was not entirely eliminated.
There were no major early postoperative complications, but two patients complained of long-term numbness across the lower abdomen. All four patients were satisfied with their esthetic improvement.
Despite the success of the technique, the authors stress that uro-abdominoplasty should be considered as a last resort, mainly in those who have exhausted conservative or simpler surgical solutions such as liposuction, stoma revision, and relocation.
By Nikki Withers