ABSTRACT
The operative details and modifications of the procedure have evolved over the years from the original disconnected reversed appendix to disconnected unreversed, undisconnected imbricated, laparoscopic antireflux/base-plicated, laparoscopic unplicated, split appendix (in conjunction with a Mirofanoff conduit), laparoscopic-assisted, or left-sided antegrade continence enema (ACE). Occasionally, an endoscopic (laparoscopic-assisted) tube placement is carried out prior to formal ACE formation to assess the potential success of the antegrade washout mechanism. Preoperative bowel preparation is highly recommended, even in a simple isolated laparoscopic ACE as one is never sure whether other surgical maneuvers may be necessary to facilitate the ACE formation. Laparoscopic surgery has made the creation of an ACE quicker and easier and has allowed results of non-imbricated and non-plicated ACEs to be assessed. The majority of surgeons now just “pull the appendix out of the stoma” without any other associated antireflux maneuvers.
