Education / Lap & Robotics / Surgical Innovations
Introduction & Objective :
Creation of an ileal conduit may be complicated by late stomal complications such as stomal stenosis or stomal retraction both of which make the adherence of an ostomy appliance problematic. These complications can be difficult to manage. Many of these complications may not occur for years following creation of the stoma. Complete resection of the old conduit with reconstruction of a new conduit using a new loop of ileum is technically challenging primarily due to difficulty performing a new uretero-ileal anastomosis. We present our experience with ileal conduit reconstruction for late stomal complications using a second segment of ileum that avoids any revision of the existing uretero-ileal anastomosis.
Eleven patients with stomal stenosis (4 patients) or stomal retraction (7 patients) underwent stomal repair 20.5 +/- 19.7 years following initial ileal conduit construction. Mean patient age was 55.5 +/- 9.8 years. The indication for the ileal conduit was bladder cancer in three patients and neurogenic bladder in eight patients (three with spinal cord injury and five with spina bifida). The five patients with spina bifida all had ileal conduit surgery as children over 40 years prior to revision. Surgery progressed in the following order: exploratory laparotomy, takedown of ostomy, excision of the stomal stenosis if necessary, selection of an ileal segment chosen to reach from the proposed neo-stoma site to the already existing sub facial conduit, restoration of bowel continuity, end-to-end ileoileostomy (old subfascial conduit to new loop which forms the stoma) and maturation of new ileal stoma.
Mean operative time was 219 +/- 54 minutes. Estimate Blood loss was 134.0 +/- 59 mL. All patients have functioning, viable stomas with a minimum of 36 months follow-up. We have observed no bowel related complications.
Surgical revisions necessary for the management of late stomal complications of ileal conduit may be technically complex. Reconstruction with additional ileal segment to create a composite conduit is a viable option with excellent outcomes. We have found this technique particularly useful in obese patients and in patients with pediatric constructed conduits.