Retrocaecal appendix: A challenge for Mitrofanoff and robotic augmentation cystoplasty

Description

Introduction
Mitrofanoff appendicovesicostomy assists children in bladder emptying. A retrocaecal appendix poses many technical challenges. We here in share our technique and approach to overcome such challenges in a child with spinal dysraphism needing both Mitrofanoff and augmentation.
Materials and method
A 7-year-old boy, a known cases of spinal dysraphism had storage lower urinary tract symptoms. The bladder capacity was < 65% for age with a compliance 10 cm/H2O. The appendix was located in retrocaecal position and couldn’t reach the bladder template in spite of generous pedicle mobilization. To overcome this bladder was mobilized and hitched to psoas. Appendix was implanted along the left anterolateral wall and the bowel patch was anastomosed along the right anterolateral wall. The da Vinci Xi system was used.

Results
The operative time was 310 minutes (excluding docking) with blood loss of 80 ml. The hospitalization time was 7 days. No intra or postoperative complications noted. On follow up the bladder capacity improved (>90% for age) and symptoms improved as per the criteria laid down by international children continence society.
Conclusion
Retrocecal appendix poses technical challenges. Bladder hitch to psoas makes it simple to bridge the gap between high lying retrocaecal appendix with short pedicle. Both appendix and bowel can be easily implanted and anastomosed respectively to the bladder template.