Abstract General Information

Title

KELLY’S VV PLASTY FOR CATHETERISING CHANNELS; FIRST REPORTED CASE SERIES

Introduction and objective

Catheterising channels (Mitrofanoff and ACE) are established techniques for managing urinary and bowel conditions, yet anastomosis to the skin can be a challenge. Direct anastomosis or the use of a V flap results in a channel opening with unsightly, visible mucosa. Other techniques are associated with a significant stenosis rates, and the VQZ technique can be difficult to learn and result in jagged scar. The Kelly VV plasty is intended to overcome some of these problems, but to date, has only been described as a point of technique. We postulated that the VV plasty can produce acceptable results when securing a catheterising channel to skin. We performed a retrospective review of patents at our institute who had undergone this technique.

Method

We used a method similar to that described by Murthi and Kelly (2006) with two trapezoid flaps, each with parallel sides about 1 cm wide, which are secured into double fish-mouth openings in the catheterising channel. Unlike the original description, we begin the anastomosis at the channel-end and work up-wards gradually creating a tunnel, and easily approximating the 1 cm wide skin defect.
We reviewed the case notes of all patients at out institution that had undergone the procedure. Results are given as median (IQR) unless stated.

Results

The technique was used in 14 patients between 2017-2023, including 9 children (median age 14) and 5 adults (median age 43). VV plasty was used in 12 who had a Mitrofanoff, of which two had Monti channels, and 2 patients who had an ACE procedure. Median catheter size at time of creating was 14 Fr.
Follow up after surgery was 25 months (7.75-58).
There were no local skin dehiscences. All patients now use 12 or 14 Fr catheters, except one who uses a 10 Fr. He is one of 4 patients who uses an ACE stopper. Pyogenic granulomas have been treated topically in 2. No patient has required revision surgery. Patients were satisfied with the cosmetic outcome.

Conclusion

In this small series, outcome is satisfactory. The Kelly VV plasty is a simple solution to skin anastomosis of catheterising channels, it is easy to master and perform. The technique merits wider adoption and evaluation.