Overcoming Obesity and a Short Appendix in the Creation of Continent Catheterizable Stomas. Preliminary Outcomes of the “Casella-Ost Procedure”

Objective To describe a novel method of using a bladder flap to partially span the distance between the bladder and abdominal wall when creating a concealed catheterizable channel. Materials and Methods We retrospectively identified 3 patients in whom we performed this reconstruction and report our surgical technique and their outcomes at 23, 27, and 32 months. Results There were no immediate operative complications and all patients continue to catheterize without difficulty. Two patients reported mild stomal stress incontinence, which resolved with Ditropan in one case, and was not bothersome enough to desire additional treatment in the second. Conclusion Incorporation of the bladder flap allows for a shorter proximal limb (appendix or tubularized ileum), improving ease of catheterization in addition to providing a surface where a tunneled, nonrefluxing anastomosis between the proximal limb and bladder can be easily performed. Long-term follow-up and greater patient numbers are needed, nonetheless, we have not seen this approach described in the literature and feel that it is an important reconstructive option to be considered when creating a continent catheterizable diversion.