V1892: Early results with a totally extraperitoneal ileal conduit
VideoIntroduction and Objectives
Incontinent urinary diversion continues to be the most widely used diversion type. Even with improved perioperative clinical care pathways, urinary diversion remains a morbid procedure. In order to improve perioperative reconvalescence and minimize bowel complications formation of a totally extraperitoneal ileal conduit is presented.
10 patients (8 male, 2 female) received radical cystectomy with extended pelvic lymphadenectomy and totally extraperitoneal ileal conduit for muscle invasive bladder cancer. Perioperative data was prospectively collected.
Mean patient age was 71 years (58 – 80) and the mean age-related Charlson comorbidity index 5.8 (3 – 8). Mean body mass index was 26.2 (18.9 – 32.7). 4/10 patients had previous abdominal surgery including one appendectomy case. No intraoperative complications occurred. Mean pathologist lymph node count was 18.3 (8 – 24). The gastric tube was clamped on the first postoperative day in every patient and removed the following day. 1/10 patients required gastric tube reinsertion. Mean time to bowel movement was 3.7 days (1 – 6). Pelvic drains were removed after a mean of 8.1 days (5 – 12). An asymptomatic postoperative lymphocele was diagnosed in 2/10 patients, but none required drainage. 5/10 patients had postoperative complications Clavien grade ≤ 2. One patient died postoperatively of myocardial infarction. Mean follow-up was 5.1 months (1 – 13). One patient was readmitted to the hospital within 90 days due to apoplectic insult. One patient had ureteric reimplantation of the left ureter eight months after cystectomy.
Tailoring of a totally extraperitoneal ileal conduit is feasible and can expedite postoperative recovery after cystectomy without being associated with a worrisome complication rate. However, pelvic drain indwelling time after extended lymphadenectomy can be prolonged.