Malone & Mitrofanoff NCH

How the appendecostomy is fashioned at the umbilicus depends on its appearance. In this case, the umbilicus is chimney-like, and therefore an easily catheterizable stoma is made by simply removing a circle of skin and the cicatrix down to the peritoneum, as demonstrated here. This is an open procedure as a child requires both a malone and a mitrofanov. The cecum is delivered through the midline laparotomy wound, and the appendix is identified. The stitch is placed at the tip of the appendix. Here you can see that the mesoapendix is clearly demonstrated, and there are blood vessels to the proximal and distal portion of the appendix with an excellent window in the meso tree where the appendix can be divided. A stitch is placed and the appendix is divided with cautery. The portion in continuity with the cecum will obviously become the alone, and the distal portion will become the mitrofanov channel. Here a window is being made in the mesentry so that the cecum can be picated around the base of the appendix to help reduce leakage with great care being taken not to interrupt the blood supply. The cecum is placated with silk sutures around the base of the appendix. A superficial bite of the appendix is taken with each stitch, ensuring that the lumen of the appendix is not narrowed. The assistant is applying gentle traction on the appendix to ensure that it remains straight. An 8 French feeding tube is passed through the appendix to ensure that the channel is easily catheterizable. The appendix will then be delivered through the umbilicus and fashioned into a catheterizezable stoma and the feeding tube left in situ. The distal end of the appendix is used for the mitrophov.