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A low‐pressure rectosigmoid pouch created by side‐to‐side anastomosis with a stapling technique and sigmoid colon intussusception as an antireflux procedure
Author(s) -
Adel Denewer
Publication year - 1998
Publication title -
british journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 0007-1331
DOI - 10.1046/j.1464-410x.1998.00649.x
Subject(s) - medicine , cystectomy , pouch , urinary diversion , surgery , anastomosis , fistula , intussusception (medical disorder) , rectum , sigmoid colon , urinary fistula , bladder cancer , cancer
Objective To assess a new procedure of urinary diversion after cystectomy for bladder cancer. Patients and methods Thirty‐two patients (14 women and 18 men, mean age 54 years, range 35–70) treated by radical cystectomy for bladder cancer underwent urinary diversion using a new technique. After mobilization of the sigmoid colon, the splenic flexure and the upper rectum, two adjacent colotomies were made to complete a stapled side‐to‐side anastomosis, with intussusception and implantation of the ureters between the layers of the intussusceptum. Two ureteric stents (8F) were brought out through the iliac fossa, and a rectal tube introduced through the anus and the intussusception to the proximal colon. The reservoir was assessed by urodynamic studies, using the anorectal perfusion catheter. Results Twenty‐eight patients were continent day and night, with mild soiling in the remaining four at night. Complications included a urinary fistula in three patients and a fecal fistula in one; all were treated conservatively. Metabolic complications occurred in only two patients. Conclusion The pouch created has a low pressure, a high capacity and provides effective continence. Surgery remains adequately radical, by removing the prostate and the membranous urethra. The implanted ureters between the layers of the intussusceptum provided an effective antireflux mechanism and markedly improved kidney function. The intussusception prevents reflux of the pouch contents into the proximal colon and minimizes metabolic complications. The technique needs neither colostomy nor small intestinal manipulations.