preparation be started well in advance. The patient should be contacted with explicit instructions to begin clear liquids at home 2 days prior to surgery and to arrive early for a preoperative admission 1 day prior to surgery. Intravenous fluids should be started at the same time that the patient begins ingestion (orally or by nasogastric tube) of GoLYTELY solution (Table 107.2). Enemas and oral antibiotics are administered as well following completion of the GoLYTELY prep, depending on the severity of the patient’s fecal load and estimated efficacy of the oral bowel prep. For patients with marginal renal function, the use of phosphate containing laxatives is contraindicated. Instead, twice-daily oral administration of polyethylene glycol 3350 beginning 3 days preoperatively as an adjunct to a clear liquid diet is sufficient to clear most children.
TABLE 107.1 TYPES AND INCIDENCES OF COMPLICATIONS FOLLOWING PEDIATRIC AUGMENTATION CYSTOPLASTY
TABLE 107.2 COMMONLY UTILIZED BOWEL CLEANSING PERFORMED PRIOR TO AUGMENTATION CYSTOPLASTY
the posterior lip of the opening with electrocautery until it is seen to spring open. This incision is not full-thickness. This defect should be closed transversely with continuous 3-0 polyglycolic acid (PGA), thus completing a Heineke-Mikulicz-like repair. The anterior cystotomy should then be closed transversely as well. (Author’s personal observation of W. H. Hendren)
TABLE 107.3 COMPARISON OF GASTROINTESTINAL SEGMENTS IN PEDIATRIC AUGMENTATION CYSTOPLASTY
the most posterior limit of the anastomotic line, thus facilitating placement of the second, reinforcing suture layer between the serosal surfaces of the bladder and ileum. A suprapubic catheter is placed through the bladder wall prior to completion of the first anastomotic closure (Fig. 107.6).
FIGURE 107.2 Blood supply to the jejunum, ileum, and ascending and transverse colon. (Reprinted with permission from Hinman F Jr, ed. Gastrointestinal tract. In: Hinman’s Atlas of Urosurgical Anatomy. Philadelphia: WB Saunders, 1993.)
FIGURE 107.3 Ileocystoplasty. A: 20- to 40-cm segment of ileum at least 15 cm from the ileocecal valve is removed and opened on its antimesenteric border. Ileoileostomy reconstitutes the bowel. B: The opened ileal segment is reconfigured. This can be done in a U, S, or W configuration. It can be further folded as a cup patch. C: The reconfigured ileal segment is anastomosed widely to the native bladder. (Reprinted with permission from Adams MC, Joseph DB. Urinary reconstruction in children. In: Wein AJ, Kavoussi LR, Novick AC, et al, eds. Campbell’s Urology, 9th ed. Philadelphia: WB Saunders, 2007.)
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