1259 THE IMPACT OF RUNNING VERSUS INTERRUPTED ANASTOMOSIS ON RATE OF URETERO-INTESTINAL STRICTURE FOLLOWING RADICAL CYSTECTOMY

Abstract

INTRODUCTION AND OBJECTIVES: Orthotopic bladder replacement (OBR) following radical cystectomy (RC), the treatment of choice for muscle-invasive bladder cancer, has gained increased popularity over the last two decades. Nevertheless, the complexity of the procedure and the additional surgical time needed for its creation continue to limit its routine use. METHODS: Data of consecutive patients with invasive bladder cancer treated with RC and ORB at two university hospitals between December 2009 and June 2011 were prospectively collected and compared according to construction modality of W ileal reservoir, namely hand-sewn (Group/hospital 1) or stapled (Group/hospital 2). In both cases, approximately 50 cm of terminal ileum were used, with an approximate length of 15 cm for the 2 lateral arms and 10 cm for the 2 medial arms. The 4 arms were then detubularised and hand-sewn in Group 1 or stapled with 10 cm metallic GIA linear stapler in Group 2. In both cases the proximal and distal 5 cm of the harvested ileum remained not-detubularised and such horns of the neobladder were used for end-to-end uretero-ileal anastomosis. Time of reservoir construction and complications occurring up to 3 months postoperatively were analyzed. RESULTS: Group 1 and Group 2 consisted of 10 and 11 patients, respectively. Mean time for reservoir construction was 6 min in Group 1 vs. 47 min in Group 2 (p 0.001). There were two cases of leakage from uretero-ileal anastomosis, one in each group, treated conservatively in Group 1 and by 6-weeks ureteric stenting in Group 2. There were no infective complications nor urinary stones in both groups. CONCLUSIONS: The stapled reservoir provided the same results of the hand-sewn reservoir with a significant reduction in surgical time. The safety, ease and speed of the stapled technique may help expanding the indication to OBR after RC.