Simplified technique to create a concealed catheterizable stoma:: The VR flap

Purpose: We describe a surgical modification of VQZ plasty, the VR flap. In addition to avoiding skin surface mucosal prolapse and preventing stenosis, this procedure is easier to describe and perform. Materials and Methods: A total of 12 patients (4 males and 8 females) 6 to 14 years old (mean age 11.6) underwent simultaneous creation of a continent catheterizable channel using the Mitrofanoff principle and MACE procedure. VQZ plasty was modified by using a quadrilateral flap positioned at a 90-degree angle from the V flap instead of immediately next to it. The quadrilateral flap is used to create a skin channel allowing the use of a shorter conduit and avoiding exposed mucosa. The modification creates a linear closure. Results: A total of 24 CCCs (Mitrofanoff 12, MACE 12) were done simultaneously in 12 patients. Of the channels 12 were implanted in the umbilicus (CCC 6, MACE 6) and 12 in a stoma created by the VR flap. There were no significant complications. One patient required surgical revision and 1 required stomal dilation for stomal stenosis. All patients were continent through all channels. Mean followup was 18 months. Conclusions: This modification offers good cosmetic and functional results, and the outcome compares favorably with other series. The procedure is easy to understand and perform, and its application is not limited by the thickness of the abdominal wall. Moreover, it allows for an easier closure and limits the Z-shaped appearance of the closure.