Malone & Mitrofanoff NCH

The appearance of the umbilicus determines how the appendicostomy is fashioned.

A chimney-like umbilicus allows creation of an easily catheterizable stoma by removing a circle of skin and the cicatrix down to the peritoneum.

This is an open procedure performed when a child requires both a Malone and a Mitrofanoff.

The appendix can be divided through a window in the mesoappendix where blood vessels supply the proximal and distal portions.

The proximal portion of the divided appendix (in continuity with cecum) becomes the Malone channel.

The distal portion of the divided appendix becomes the Mitrofanoff channel.

A window is made in the mesentery to allow cecal plication around the appendix base to help reduce leakage.

Great care must be taken not to interrupt the blood supply during cecal plication.

The cecum is plicated with silk sutures around the base of the appendix.

A superficial bite of the appendix is taken with each stitch to ensure the lumen is not narrowed.

Gentle traction is applied to the appendix during suturing to ensure it remains straight.

An 8 French feeding tube is passed through the appendix to ensure the channel is easily catheterizable.

The appendix is delivered through the umbilicus and fashioned into a catheterizable stoma with the feeding tube left in situ.