Wael M Moneir, Amr Hodhod, Ahmad Alshammari, Sultan Almaiman, Abdullah Alrumaih, Abdulwahab Alhams, Abdullah Alaqeel, Fayez Almodhen, Yasser Jamalalail, Tariq Burki
At a median age (range) of 10 (3-17) years, seventy channels were created in 69 patients, including 48 APV and 22 Monti conduits, with a median follow-up of 36.5 months. Mitrofanoff-related complications were seen with 23 APV and 16 Monti channels (P = 0.052). Overall, 45.7% of patients required revision. Revisions were required in 19 APV and 13 Monti channels (P = 0.128). More than one revision was necessary in 10 conduits, six of which were Monti channels (P = 0.209). Kaplan-Meier analysis demonstrated a marked early decline in revision-free survival, with most revisions occurring within the first 18 months postoperatively. Conduit type was the only independent predictor of revision (HR 2.60, 95% CI 1.05-6.44, P = 0.038), with Monti channels demonstrating a higher hazard than APV. Age at surgery was not an independent predictor (HR 1.19 per year, 95% CI 0.98-1.43, P = 0.075). Time-stratified analysis demonstrated no significant predictors in either the early or late postoperative periods.
OBJECTIVE: Appendicovesicostomy (APV) and Monti enteric channels are commonly used catheterisable channels utilizing the Mitrofanoff principle. However, their long-term durability and predictors of revision remain uncertain. This study aimed to evaluate revision-free survival and identify predictors of revision following APV and Monti channel creation.
PATIENTS AND METHODS: We conducted a retrospective study of children less than 18 years old undergoing CCC creation using APV or Monti at two tertiary care hospitals between 2015 and 2024. Categorical data were evaluated using Fisher's exact test, while continuous data were compared using the Mann-Whitney U test. Time-to-event analysis was performed using Kaplan-Meier methods and Cox proportional hazards regression to assess revision-free survival and identify predictors of surgical revision.
RESULTS: At a median age (range) of 10 (3-17) years, seventy channels were created in 69 patients, including 48 APV and 22 Monti conduits, with a median follow-up of 36.5 months. Mitrofanoff-related complications were seen with 23 APV and 16 Monti channels (P = 0.052). Overall, 45.7% of patients required revision. Revisions were required in 19 APV and 13 Monti channels (P = 0.128). More than one revision was necessary in 10 conduits, six of which were Monti channels (P = 0.209). Kaplan-Meier analysis demonstrated a marked early decline in revision-free survival, with most revisions occurring within the first 18 months postoperatively. Conduit type was the only independent predictor of revision (HR 2.60, 95% CI 1.05-6.44, P = 0.038), with Monti channels demonstrating a higher hazard than APV. Age at surgery was not an independent predictor (HR 1.19 per year, 95% CI 0.98-1.43, P = 0.075). Time-stratified analysis demonstrated no significant predictors in either the early or late postoperative periods.
COMMENT AND CONCLUSIONS: CCC creation is associated with a high rate of early revisions, with most failures occurring within the first 18 months. Monti channels were associated with a higher adjusted hazard of revision than APV, while age at surgery was not independently associated with outcome. These findings underscore the importance of patient counseling, structured follow-up protocols, and early surveillance for complications.