Evaluation of findings during re‐exploration for obstructive ileus after radical cystectomy and ileal‐loop urinary diversion: insight into potential technical improvements

• Published in: BJU international 2007-04, Vol.99 (4), p.893-897
• Main Authors: Varkarakis, Ioannis M., Chrisofos, Michalis, Antoniou, Nikolaos, Papatsoris, Athanasios, Deliveliotis, Charalambos
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; bladder cancer; Carcinoma, Transitional Cell - surgery; complications; Cystectomy - methods; Cystectomy - standards; Female; Humans; ileus; Ileus - etiology; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Prosthesis Failure; radical cystectomy; Reoperation; Retrospective Studies; Secondary Prevention; Tumors of the urinary system; Urinary Bladder Neoplasms - surgery; Urinary Diversion - methods; Urinary Diversion - standards; Urinary Reservoirs, Continent - standards; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/j.1464-410X.2006.06644.x

Authors from Greece evaluated their experience of findings during re‐exploration for small bowel obstruction after radical cystectomy. They found several abnormalities, more particularly unexpected, to account for this, and drew some conclusions as to the operative technique that might help to prevent them. OBJECTIVE To retrospectively evaluate the findings during re‐exploration for obstructive ileus after radical cystectomy (RC) and ileal conduit diversion. PATIENTS AND METHODS During a 12‐year period, 434 patients who had RC and ileal conduit diversion were retrospectively evaluated for the diagnosis of early (≤30 days after RC) or late abdominal re‐exploration. The operative reports of patients requiring a second abdominal procedure were reviewed, evaluating in particular the reason for small bowel obstruction (SBO). In addition, the type of entero‐enteric anastomosis and the retroperitonealization of the uretero‐enteric anastomosis were compared between patients who required abdominal re‐exploration for SBO and those who did not. RESULTS Abdominal re‐exploration for SBO was necessary for 14 (3.2%) and 32 (7.3%) patients in the early and late postoperative period, respectively. The most common reasons for SBO were anastomotic malfunction (1.4%) and malignant recurrence (2.8%). Adhesions were the second most common cause leading to ileus in both periods (1.1% and 2.3%, respectively). When there was no retroperitonealization of the uretero‐enteric anastomosis, SBO occurred more often both early and late (P = 0.06). Early anastomotic malfunction leading to SBO was more common (but not statistically significant, P = 0.06) when the entero‐enteric anastomosis was hand‐sutured end‐to‐end. CONCLUSIONS Anastomotic malfunction, bowel adhesions and internal hernias are responsible for SBO early after surgery. The above reasons, in addition to malignant recurrence, are the most common reasons for SBO in the late postoperative period.