Modified Wallace anastomotic technique reduces ureteroenteric stricture rates after ileal conduit urinary diversion

Kavaric, Petar; Eldin, Sabovic; Nenad, Radovic; Dragan, Pratljacic; Vuković, Marko

doi:10.1590/s1677-5538.ibju.2019.0417

Cited by 13 publications

(6 citation statements)

References 27 publications

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“…The documentary on applying different ureteroileal anastomosis techniques in recent years was reviewed, focusing on anastomotic leak and stricture compared with the present results (Table 4 ). Despite modifications, the Bricker anastomosis is still prone to anastomotic stricture, while the Wallace anastomosis is more likely to cause anastomotic leak [ 5 , 9 , 11 , 13 ]. The present anastomosis procedure led to a significantly lower incidence of anastomotic stricture (2.1%) than the two anastomosis techniques above and did not result in anastomotic leak in any patient.…”

Section: Discussionmentioning

confidence: 99%

“…Ileal conduit reconstruction involved ureteral anastomosis at the ends of both ureters combined with end-to-end insertion into the proximal end of the ileal loop. According to the modified Clavien classification system [ 5 ], all surgical complications were recorded. The present study focused on evaluating the long-term postoperative complications after surgery, especially the incidence of anastomotic stricture and hydroureteronephrosis.…”

Section: Methodsmentioning

confidence: 99%

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Ureteral distal ends combined and inserted into the ileum: a novel anastomotic technique for urinary diversion

Wang

Tang

et al. 2021

BMC Urol

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Background This study aimed to introduce a novel method for ureteroileal anastomosis, explore its clinical effectiveness, observe the incidence of postoperative anastomotic stricture, and compare the postoperative complications with those of other types of ureteroileal anastomosis reported in the literature. Methods Both ureters were first anastomosed at their distal ends and then inserted into the proximal end of the ileal loop. A postoperative follow-up analysis was performed to evaluate major complication indicators, including anastomotic stricture, anastomotic leak, and hydroureteronephrosis. Results We successfully performed ureteral distal ends anastomosis combined with end-to-end insertion into the ileum for 143 patients. The mean postoperative follow-up lasted 37 months (range: 10–68 months). There was no occurrence of an anastomotic leak. The incidence of anastomotic stricture combined with hydronephrosis, ileal conduit stones, urinary tract infection, and renal dysfunction were 2.1%, 0.7%, 2.1%, and 4.2%, respectively. Conclusion Ureteral distal ends combined and inserted into the ileum were simple to perform and helped achieve precise anastomosis with fewer postoperative complications.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Ureteral distal ends combined and inserted into the ileum: a novel anastomotic technique for urinary diversion

Wang

Tang

et al. 2021

BMC Urol

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“…The other common complications associated with ileal conduit diversion include pyelonephriti (5-23%), urinary calculi (3-16%) and stomal complications [27]. In a study by Kavaric et al [28] using modified Wallece technique, the most common postoperative complication following ileal conduit was pyelonephritis followed by pneumonia, paralytic ileus and anastomotic leakage. In our study, pyelonephritis was found in three patients and stomal complications in three patients and ileus in nine patients.…”

Section: Discussionmentioning

confidence: 99%

Comparison of stapler and handsewn anastomosis techniques in creating an ileal conduit following radical cystectomy

Çakmak¹,

Halis²,

Gönüllü³

et al. 2021

JOMH

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Background and objective: Ileal conduit for urinary diversion can be completed using either end-to-end handsewn or stapled anastomosis. This study aimed to compare stepled and handsewn anastomosis methods in terms of complications, hospitalization and cost. Materials and methods: Forty-three patients were included in the hand-sewn and 44 patients in the stapler group. After creating an ileal conduit, continuity of the loop was achieved either with handsewn or stapler method. Patients' demographic data, time to onset of bowel movement, time to transit to oral intake, time to removal of the drain, perioperative and postoperative complications, mortality and total costs were retrospectively recorded and compared between the two groups. Results: There was no statistically significant difference between the groups in terms of the mean to the onset of bowel movements (p = 0.51) and the mean time to transit to oral intake (p = 0.23). The mean time to removal of the drain was significantly lower in the stapler group (p = 0.023). Perioperative complications were seen in eight patients in the handsewn group, while none of the patients in the stapler group developed perioperative complication (p = 0.003). Postoperative complications were similar between both groups (p = 0.75). The duration of hospitalization was statistically significantly lower in the stapler group (p = 0.004) and the mean total cost was statistically significantly more advantageous (p < 0.001). Conclusion: No significant difference was found between stapler and handsewn anastomosis techniques in terms of postoperative complications. On the other hand, hospitalization and total cost were in favour of stapler technique, showing that this technique can be used safely.

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“…The length of forceps may be helpful to objectively measure the length of ureteral spatulation (Figure 1B), allowing us to standardize the length of ureteral orifice. We adopted a spatulated length of at least 1 inch for the ureteral orifice in the light of previous literature and diameter of the ileum [17,32]. After retrospectively reviewing the medical records of patients with MIBC treated with RARC between 2013 and 2021, we compared the incidence of UES before (January 2020) and after (February 2020) the adoption of the aforementioned standardization techniques (Table 2).…”

Section: Preventionmentioning

confidence: 99%

Incidence, Etiology, Prevention and Management of Ureteroenteric Strictures after Robot-Assisted Radical Cystectomy: A Review of Published Evidence and Personal Experience

et al. 2021

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Benign ureteroenteric anastomosis strictures (UESs) are one of many critical complications that may cause irreversible disability following robot-assisted radical cystectomy (RARC). Previous studies have shown that the incidence rates of UES after RARC can reach 25.3%, with RARC having higher UES incidence rates compared to open radical cystectomy. Various known and unknown factors are involved in the occurrence of UES. To minimize the incidence of UES after RARC, our group has standardized the procedure and technique for intracorporeal urinary diversion by applying the following five strategies: (1) wide delicate dissection of the ureter and preservation of the periureteral tissues; (2) gentle handling of the ureter and security of periureteral tissues at the anastomotic site; (3) use of indocyanine green to confirm good blood supply; (4) standardization of the ample ureteral spatulation length for Wallace ureteroenteric anastomosis through objective measurements; and (5) development of an institutional standardized procedure manual. This review focused on the incidence, etiology, prevention, and management of UES after RARC to bring attention to the incidence of this complication while also proposing standardized surgical procedures to minimize its incidence after RARC.

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Modified Wallace anastomotic technique reduces ureteroenteric stricture rates after ileal conduit urinary diversion

Cited by 13 publications

References 27 publications

Ureteral distal ends combined and inserted into the ileum: a novel anastomotic technique for urinary diversion

Ureteral distal ends combined and inserted into the ileum: a novel anastomotic technique for urinary diversion

Comparison of stapler and handsewn anastomosis techniques in creating an ileal conduit following radical cystectomy

Incidence, Etiology, Prevention and Management of Ureteroenteric Strictures after Robot-Assisted Radical Cystectomy: A Review of Published Evidence and Personal Experience

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