The Mitrofanoff appendicovesicostomy is a pivotal surgical innovation for creating continent urinary diversions. It is particularly beneficial for patients requiring simultaneous urinary and fecal diversion via a split appendix approach, despite concerns about the vascular integrity of the divided mesoappendiceal pedicle. This study integrates a retrospective analysis with a systematic review and meta-analysis to evaluate the outcomes and complications associated with intact versus split appendix techniques.

After obtaining the necessary approval from the institutional Research Ethics Board (1000054451), a single-center retrospective cohort analysis was conducted at a tertiary referral pediatric hospital focused on patients who underwent either an intact or split appendix laparoscopic-assisted Mitrofanoff procedure between January 2005 and December 2016. The focus was on complications related to both Mitrofanoff and ACE channels. Kaplan-Meier survival analysis, log-rank tests, and Cox regression were utilized to determine hazard ratios. Additionally, a PROSPERO (CRD42023481627)-registered systematic review and meta-analysis were conducted, evaluating complication rates across diverse patient populations using the Mantel-Haenszel method with a random-effects model.

A total of 22 patients with intact appendix Mitrofanoff and 10 with split appendix for both Mitrofanoff and ACE creation were compared. The time to complications did not differ significantly, with a log-rank p-value of 0.72. The adjusted hazard ratio for the split appendix group was 1.26 (95% CI: 0.32-4.99). The systematic review and meta-analysis included 565 patients and indicated a higher, albeit non-significant, complication rate in the split appendix group (29.2%) compared to the intact group (20.4%), with an odds ratio of 1.49 (95% CI: 0.82-2.73).

The analysis showed that, compared to appendicovesicostomy performed in isolation, the split appendix technique may be associated with slightly higher complication rates, though not statistically significant. The choice of surgical technique should be tailored to the individual anatomical and functional needs of patients, emphasizing the importance of personalized surgical planning and skilled execution.