Ureteroileal anastomotic strictures after a Bricker ileal conduit: 50 case assessment of the impact of conversion from a slit incision to a "shield shaped" ileotomy

Marina Cheng, Stephen Warwick Looney, James A. Brown

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6 Citations (Scopus)

Abstract

Purpose: Ureteroileal anastomotic stricture is a late complication of Bricker ileal conduits. We report our utilization of a "shield shaped" rather than a standard slit ileotomy. Materials and methods: We retrospectively reviewed a single surgeon's experience performing Bricker ileal conduits, initially using a slit incision, then a shield shaped ileotomy. Patient demographics, type of ileotomy, indication, history of prior radiation or chemotherapy, development of postoperative ureteroileal anastomotic stricture, date of stricture diagnosis, imaging modality, stricture treatment, outcome, and length of follow up were recorded. Results: A total of 50 ileal conduit patients were identified between 2001-2009. A traditional slit incision ileotomy was performed in 25 patients (Group 1) and a shield shaped ileotomy was performed in the following 25 (Group 2). After excluding 1 patient in each group that died within 90 days postoperatively, a total of 95 renal units were anastomosed, (Group 1: 24 patients, 48 renal units, 2001-2005; and Group 2: 24 patients, 47 renal units, 2006-2009). A total of 8 (8.3%) ureteroileal anastomotic strictures were identified: 6 (12.5%) in Group 1, including 1 with bilateral strictures, and 2 (4.3%) in Group 2. Stricture diagnosis occurred at 1, 4, 4, 5, 14 and 42 months in Group 1, and at 6 and 10 months in Group 2. Mean follow up was 24.2 (2-85) months and 12.3 (2-26) months for each cohort, respectively. No increase in postoperative anastomotic leakage was identified. Conclusions: Modifying the standard ileotomy slit to a shield shaped incision does not eliminate postoperative anastomotic strictures. This technique provides greater visualization of the suture line, making it technically easier to perform.

Original languageEnglish (US)
Pages (from-to)5644-5649
Number of pages6
JournalCanadian Journal of Urology
Volume18
Issue number2
StatePublished - Apr 1 2011

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Urinary Diversion
Pathologic Constriction
Kidney
Anastomotic Leak
Sutures
Demography
Radiation
Drug Therapy

Keywords

  • Adulthood
  • Late diagnosis
  • Outcome
  • Posterior urethral valves

ASJC Scopus subject areas

  • Urology

Cite this

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title = "Ureteroileal anastomotic strictures after a Bricker ileal conduit: 50 case assessment of the impact of conversion from a slit incision to a {"}shield shaped{"} ileotomy",
abstract = "Purpose: Ureteroileal anastomotic stricture is a late complication of Bricker ileal conduits. We report our utilization of a {"}shield shaped{"} rather than a standard slit ileotomy. Materials and methods: We retrospectively reviewed a single surgeon's experience performing Bricker ileal conduits, initially using a slit incision, then a shield shaped ileotomy. Patient demographics, type of ileotomy, indication, history of prior radiation or chemotherapy, development of postoperative ureteroileal anastomotic stricture, date of stricture diagnosis, imaging modality, stricture treatment, outcome, and length of follow up were recorded. Results: A total of 50 ileal conduit patients were identified between 2001-2009. A traditional slit incision ileotomy was performed in 25 patients (Group 1) and a shield shaped ileotomy was performed in the following 25 (Group 2). After excluding 1 patient in each group that died within 90 days postoperatively, a total of 95 renal units were anastomosed, (Group 1: 24 patients, 48 renal units, 2001-2005; and Group 2: 24 patients, 47 renal units, 2006-2009). A total of 8 (8.3{\%}) ureteroileal anastomotic strictures were identified: 6 (12.5{\%}) in Group 1, including 1 with bilateral strictures, and 2 (4.3{\%}) in Group 2. Stricture diagnosis occurred at 1, 4, 4, 5, 14 and 42 months in Group 1, and at 6 and 10 months in Group 2. Mean follow up was 24.2 (2-85) months and 12.3 (2-26) months for each cohort, respectively. No increase in postoperative anastomotic leakage was identified. Conclusions: Modifying the standard ileotomy slit to a shield shaped incision does not eliminate postoperative anastomotic strictures. This technique provides greater visualization of the suture line, making it technically easier to perform.",
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AU - Looney, Stephen Warwick

AU - Brown, James A.

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N2 - Purpose: Ureteroileal anastomotic stricture is a late complication of Bricker ileal conduits. We report our utilization of a "shield shaped" rather than a standard slit ileotomy. Materials and methods: We retrospectively reviewed a single surgeon's experience performing Bricker ileal conduits, initially using a slit incision, then a shield shaped ileotomy. Patient demographics, type of ileotomy, indication, history of prior radiation or chemotherapy, development of postoperative ureteroileal anastomotic stricture, date of stricture diagnosis, imaging modality, stricture treatment, outcome, and length of follow up were recorded. Results: A total of 50 ileal conduit patients were identified between 2001-2009. A traditional slit incision ileotomy was performed in 25 patients (Group 1) and a shield shaped ileotomy was performed in the following 25 (Group 2). After excluding 1 patient in each group that died within 90 days postoperatively, a total of 95 renal units were anastomosed, (Group 1: 24 patients, 48 renal units, 2001-2005; and Group 2: 24 patients, 47 renal units, 2006-2009). A total of 8 (8.3%) ureteroileal anastomotic strictures were identified: 6 (12.5%) in Group 1, including 1 with bilateral strictures, and 2 (4.3%) in Group 2. Stricture diagnosis occurred at 1, 4, 4, 5, 14 and 42 months in Group 1, and at 6 and 10 months in Group 2. Mean follow up was 24.2 (2-85) months and 12.3 (2-26) months for each cohort, respectively. No increase in postoperative anastomotic leakage was identified. Conclusions: Modifying the standard ileotomy slit to a shield shaped incision does not eliminate postoperative anastomotic strictures. This technique provides greater visualization of the suture line, making it technically easier to perform.

AB - Purpose: Ureteroileal anastomotic stricture is a late complication of Bricker ileal conduits. We report our utilization of a "shield shaped" rather than a standard slit ileotomy. Materials and methods: We retrospectively reviewed a single surgeon's experience performing Bricker ileal conduits, initially using a slit incision, then a shield shaped ileotomy. Patient demographics, type of ileotomy, indication, history of prior radiation or chemotherapy, development of postoperative ureteroileal anastomotic stricture, date of stricture diagnosis, imaging modality, stricture treatment, outcome, and length of follow up were recorded. Results: A total of 50 ileal conduit patients were identified between 2001-2009. A traditional slit incision ileotomy was performed in 25 patients (Group 1) and a shield shaped ileotomy was performed in the following 25 (Group 2). After excluding 1 patient in each group that died within 90 days postoperatively, a total of 95 renal units were anastomosed, (Group 1: 24 patients, 48 renal units, 2001-2005; and Group 2: 24 patients, 47 renal units, 2006-2009). A total of 8 (8.3%) ureteroileal anastomotic strictures were identified: 6 (12.5%) in Group 1, including 1 with bilateral strictures, and 2 (4.3%) in Group 2. Stricture diagnosis occurred at 1, 4, 4, 5, 14 and 42 months in Group 1, and at 6 and 10 months in Group 2. Mean follow up was 24.2 (2-85) months and 12.3 (2-26) months for each cohort, respectively. No increase in postoperative anastomotic leakage was identified. Conclusions: Modifying the standard ileotomy slit to a shield shaped incision does not eliminate postoperative anastomotic strictures. This technique provides greater visualization of the suture line, making it technically easier to perform.

KW - Adulthood

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