Evaluation of findings during re-exploration for obstructive ileus after radical cystectomy and ileal-loop urinary diversion: insight into potential technical improvements.
OBJECTIVE
To retrospectively evaluate the findings during re-exploration for obstructive ileus after radical cystectomy (RC) and ileal conduit diversion.


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.
Varkarakis
Ioannis M
IM
2nd Department of Urology, Athens University, Sismanoglio Hospital, Athens, Greece. medvark3@yahoo.com
Chrisofos
Michalis
M
Antoniou
Nikolaos
N
Papatsoris
Athanasios
A
Deliveliotis
Charalambos
C
D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D015653:Cystectomy / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D045823:Ileus / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies; D055502:Secondary Prevention; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods / Q000592:standards*; D016476:Urinary Reservoirs, Continent / Q000592:standards*