Faculty Collaboration Database

Is mesenteric defect closure needed in urologic surgery using ileum? Can J Urol 2018 Jun;25(3):9334-9339

Date

06/15/2018

Pubmed ID

29900822

Scopus ID

2-s2.0-85048637944 (requires institutional sign-in at Scopus site)

Abstract

INTRODUCTION: Classic surgical teaching advocates for closure of the mesenteric defect (MD) after bowel anastomosis but the necessity is controversial. We sought to evaluate the necessity of MD closure at the time of harvest of ileum for genitourinary reconstructive surgery (GURS) by analyzing the incidence of early and late gastrointestinal adverse events (GIAE) in patients with and without MD closure.

MATERIALS AND METHODS: A retrospective review was conducted on patients undergoing urologic reconstruction with ileum to identify incidence of ileus, small bowel obstruction (SBO), gastrointestinal (GI) fistula and stoma complications. Patient and procedure variables were analyzed to identify risk factors for GIAE.

RESULTS: A total of 288 patients met inclusion criteria and 93% of GURS was for urinary diversion following cystectomy. MD was closed in 194 cases (67%). Median follow up was 19 months. Early (< 30 day) GIAE rates were 16.5% (n = 32) and 21.3% (n = 20) in the closure and non-closure groups, respectively (p = 0.22). The rate of early ileus/SBO requiring nasogastric tube decompression or laparotomy were similar after closure (15.0%) and non-closure (21.3%) (p = .18). The late GIAE rates were 5.7% (n = 11) and 6.4% (n = 6) in the closure and non-closure cohorts, respectively (p = 0.56). The rate of late SBO were similar and no cases of early or late SBO in either cohort were due to internal herniation. On multivariate analysis, increasing BMI was associated with both early and late GIAE.

CONCLUSIONS: After harvesting ileum for urologic reconstruction, the MD can safely be left open as we found no association between non-closure and early or late GIAE..

Author List

Avallone MA, Dietrich PN, Shepherd ST, Lalehzari M, O'Connor RC, Guralnick ML

Authors

Michael Guralnick MD Professor in the Urologic Surgery department at Medical College of Wisconsin
Robert Corey O'Connor MD Professor in the Urologic Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Anastomosis, Surgical
Cohort Studies
Cystectomy
Female
Follow-Up Studies
Humans
Ileum
Intestinal Obstruction
Intraoperative Complications
Male
Mesentery
Middle Aged
Retrospective Studies
Risk Assessment
Tissue and Organ Harvesting
Treatment Outcome
Urinary Diversion