INTRODUCTION AND OBJECTIVES: To evaluate the versatility of this principle and its aptness to various situations in pediatric reconstructive surgery and we provide a video showing the fine technical details.

METHODS: Over the past 9 years, Serous Lined Extramural Tunnel Principle was used in 11 patients with a mean age of 11 years (6-17). Indications were Conversion from ileal loop conduit to continent catheterizable stoma in 2 (1 PUV, 1 pelvic rhabdomyosarcoma) or creation of catheterizable channel in bladder augmentation in 9 (1 PUV, 3 spina bifida, 5 bladder exstrophy). Associated procedures were (1 bladder neck closure, 2 Sling, 5 Mitchell BNR, 2 Malone antegrade continent enema). Appendix was used to creat the outlet in 7 while Monti was used in 4)

RESULTS: In all patients the stoma was successfully matured to the umbilicus.There were no postoperative complications or difficult catheterization. In the first 3 months all patients were completely continent. Three/11 (27%) patients developed secondary incontinence 3-6 months after surgery. Injection of Macroplastique in 1 and Deflux in 2 was tried unsuccessfully. Surgical revision revealed a de-ssusception of the tunnel in the 3 patients (All of whom had Monti as an outlet where the mesentery was left outside the tunnel). The remaining 8 (73%) patients remained totally continent with a mean follow up of 2.4 years (2-4).

CONCLUSIONS: This technique is very versatile. can be used as primary or salvage surgery. The stoma can always be brought to the umbilicus. The appendix is the preferred continent outlet. Fine surgical details are crucial for success, including: Fixation of the outer pouch wall of the tunnel to the anterior abdominal wall surrounding the stoma The use of interrupted non-absorbable sutures in the posterior wall of the tunnel. One disadvantage of the technique is that injection of bulking agent is not useful in treatment of secondary incontinence

Source of Funding: None