The clinical application of wrapping ureter by a pedicled gastrocolic omentum flap during cutaneous ureterostomy

Abstract

Objective To discuss the effect and value of wrapping ureter by a pedicled gastrocolic omentum flap during cutaneous ureterostomy as urinary diversion after radical cystectomy. Methods The clinical data of 12 cases(7 males and 5 females)with bladder cancer during January 2016 and September 2017 were retrospectively analyzed.The median age was 77 years(range 75-83 ), and the course of the disease was 5 days to 2 years. 11 cases had gross hematuria, 5 cases had frequent and urgent urination, 1 case had lower abdominal pain, and 1 case had no obvious clinical symptoms.9 cases had a history of transurethral prostatic resection. 8 cases had a complication of hypertension, 5 cases had a complication of diabetes, 7 cases had a complication of cardiovascular and cerebrovascular diseases, and 6 cases had a complication of anemia. The ASA level was 3 in 9 cases and was level 4 in 3 cases.All the patiants were diagnosed of bladder urothelial carcinoma by biopsy. There were 8 cases with T3 tumor and 4 cases with T4.All the patients underwent laparoscopic radical cystectomy under general anesthesia, and wrapping ureter by a pedicled gastrocolic omentum flap during cutaneous ureterostomy was used for urinary diversion.Take a segment of 3-5 cm wide pedicle omentum, which is covered from the distal end of the ureter to the end, and use a 4-0 absorbable line to fix the omentum and ureteral outer membrane, and then perform ureterocutaneostomy. The incidence of postoperative anastomotic stenosis, hydronephrosis and wound infection were observed. Results All the operations were performed successfully without obvious operative complications.The mean operating duration was125(95-217)mins, estimated volume of blood loss 120(50-600)ml. 5 days after surgery, 1 patient developed incision infection, which was cured by strengthening anti-infection drug therapy and wound dressing. No complications such as urinary fistula, intestinal fistula and peripheral hernia occurred. No death was reported during perioperative period.Single J tube was removed 1-3 months after surgery. Within a follow-up of 12(3-23)months, 1 case died of cerebral infarction 3 months after surgery, 1 case occurred papilla light constriction without special treatment, no ureteral stenosis and necrosis cases and there were no cases of hydronephrosis. All the patients were satisfied with the quality of life after surgery. Conclusions Wrapping ureter by a pedicled gastrocolic omentum flap during cutaneous ureterostomy is simple, safe and effective as urinary diversion after radical cystectomy. Key words: Bladder cancer; Urinary diversion; Cutaneous ureterostomy; Pedicled gastrocolic omentum flap