ABSTRACT
The AFEC is a variation of the standard cup-patch technique popularized by Goodwin and
associates at UCLA (7). AFEC is performed through an extraperitoneal approach to the bladder
with retrieval and then harvest of an ileal segment through a small peritoneal window. Care is
taken to avoid significant manipulation of the intraperitoneal contents by working through a small
peritoneotomy. Reconstitution of the GI tract (ileoileostomy) is performed extraperitoneally and
then the anastomosed bowel is returned into the peritoneal cavity through the small peritoneal
window. The peritoneal window is closed against the base of the mesentery of the harvested
bowel segment, sealing the vesicointestinal anastomosis from the peritoneal cavity and placing
the harvested segment in an extraperitoneal location adjacent to the bladder. A broad-based
anterior bladder flap is fashioned and reflected cephalad where a wide vesicointestinal anastomosis
is performed extraperitoneally. We feel this modified technique of augmentation cystoplasty may
be associated with a faster return to bowel function and a shorter hospital stay.
