Q: Dr. Eppley, In February 2012 I had a Mitrofanoff diversion done using small intestine. (appendicovesicostomy) Cathing thru the stoma has been a problem since day one. The hole keeps shrinking. Have to “punch thru” for each cath. Usually bleeds, plus painful. One stoma revision done last summer which lasted a few weeks. The urologist has suggested plastic surgery but I am skeptical and tired or surgeries. The total problem was radiation damage from prostate cancer treatment.
A: I think in the face of radiation, it is virtually impossible to keep a stoma open by any type of ‘simple’ scar revision around the stoma. As taking the same tissue that have been exposed to radiation and asking it to heal without shrinking by scar contracture will not work. These are not normal tissues. Any hope of sustained stoma enlargement must occur by altering the involved tissues to have improved vascularity. This could be done by injectable fat grafting around the stoma which adds healthy fat and stem cells and then secondarily performing an interpositional skin graft to the stoma opening. But this approach would be hard to get enthusiastic about when one has had repeated surgeries that did not work.
Dr. Barry Eppley