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Techniques in Reconstructive Surgery

Laparoscopic-Assisted Reconstructive Surgery

Reconstructive surgery can allow children with congenital or acquired abnormalities to lead a more normal life. For example, there is no question of the value of surgery that allows children to be socially continent of urine or feces. On the other hand, such operations have traditionally been performed through long midline abdominal incisions, leaving a large abdominal scar. We have advanced a technique that allows us to perform a number of reconstructive operations (bladder augmentation, bladder neck reconstruction, fascial sling, continent urinary stomas, continent fecal stomas) without large abdominal scars.

When we examined the reasons for a large abdominal incision for most reconstructive operations, we found that the upper portion of the incision was only needed for the preliminary steps. For most of these procedures, colon, small intestine, stomach, appendix or a combination of these are used to rebuild the bladder or create a catheterizeable stoma. Getting these structures to reach the area of the bladder often involves work in the upper abdomen. Once the structures are mobilized, however, the reconstructive work is all carried out in the pelvis. It is the reconstructive portion of the operation that requires complex dissection and suturing that is difficult to perform laparoscopically.

What we have done is to combine the best of both approaches: using the laparoscope to free the structures in the upper abdomen and then performing the reconstructive steps of the operation through a small “bikini” or lower midline incision. This allows us to accomplish three goals:

Less manipulation in the abdomen, which will hopefully result in less scar tissue on the inside.
Quicker recovery times and less time in the hospital on average with no increase in operating room time.
Major reconstructive operations with minimal scar: a vastly improved cosmetic result.

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