ABSTRACT
Answer: (a)Bladderautoaugmentationis an ideal operation for adaptation to laparoscopy. Unfortunately, the long-term results, especially in children with low bladder volume, have been poor. The operation can be done transperitoneally or preperitoneally, the risk for bladder perforation and stones is probably lower than for gastrointestinal augmentation, and the dissection of bladder muscle off of detrusor, while potentially difficult, is reasonably accomplished laparoscopically. (Page 959)
4. All of the following are important technical points in laparoscopic ileocystoplasty except:
(a) Ileal detubularization (b) Wide bladder opening (c) Tension-free anastomosis (d) Adequate postoperative drainage (e) Intracorporeal bowel anastomosis
Answer: (e)Laparoscopicilealaugmentation has been done with both extra-and
intracorporeal bowel anastomosis, with little effect on outcome. The others are important to any intestinal bladder augmentation, regardless of approach. (Page 962)
5. Umbilical access as most commonly described for a laparoscopic-assisted bladder reconstruction with appendicovesicostomy:
(a) Incorporates a 3 mm trocar (b) Is obtained through an open approach after
creating a posterior umbilical skin flap (c) Should not be used in order to preserve
umbilicus for stoma
posterior umbilicus with Veress needle
(e) Is enlarged in order to perform the open portion of the procedure
Answer: (b) In the typically described laparoscopic-assisted reconstruction, a posterior umbilical flap is created in order to make a concealed umbilical stoma at the end of the case. Open access is then obtained using a radially dilating 10 mm trocar. The open portion of the procedure is performed through a low incision, usually a Pfannensteil.
