Is it necessary to pass the left ureter under the mesosigmoid in Bricker Ileal Conduit surgery?

Abstract

Background: No research has explored the need for the left ureter to be passed through the subsigmoid in ileal conduit diversion surgery. Due to the potential harm and lack of proven benefits of this practice, we used a simple modified technique in ileal conduit with the left ureter directly over the sigmoid colon. To investigate the feasibility of our surgical technique, as well as to evaluate perioperative outcomes and postoperative complications with a focus on the rate of small bowel obstruction (SBO) and ureteroileal anastomotic stricture (UAS).Methods: Between January 2018 and April 2020, a prospective single-center cohort of 84 consecutive patients undergoing laparoscopic radical cystectomy (LRC) and ileal conduit urinary diversion was analyzed. A study group of 30 patients receiving the modified technique was compared with a control group of 54 patients receiving the standard Bricker ileal conduit, and the differences in the incidence of SBO and UAS, perioperative results, and postoperative complications were analyzed.Results: The two groups were comparable concerning patient characteristics and clinicopathologic features. No differences were observed in terms of the operation time, perioperative outcomes, and short-term (<90 days) postoperative complications between the two groups. No case of UAS was observed in the modified group, whereas two (3.70%) cases of UAS (p = 0.535) occurred in the patients who underwent Bricker’s ureteroileal anastomosis.Conclusion: In our study, we describe a simple and feasible modified technique in ileal conduit. Compared with traditional techniques, our method has some advantages, including the ability to avoid compression of the left ureter from the mesentery without establishing a retrosigmoid tunnel, a low rate of UAS, and the ability to perform a secondary operation in the long-term follow-up.