Search

Purpose: An entero-neovesical fistula (ENF) is a rare troublesome complication of an orthotopic ileal bladder substitution. We report on a novel, safe technique to close ileal neovesical fistulas without extensive adhesiolysis using an NK-stapler (ENDOPATH® ENDOCUTTER ETS; Johnson & Johnson, Cincinnati, OH, USA). Patients: We treated two cases of postoperative ENF after orthotopic ileal bladder substitution for radical cystectomy. Case 1 was a 63-year-old male with occasional fecaluria, and Case 2 was a 73-year-old male who experienced continuous fecaluria. Surgical procedure After laparotomy, we mobilized the ascending colon to bypass the anastomosis of the primary surgery by an ileo-ileal, ileo-ascending colon anastomosis. The distance between the fistula and bypass was about 10 cm. We made tunnels in the mesentery between the bypass and fistula, without damaging blood vessels, to insert the jaw of the NK-stapler. We closed the afferent and efferent loops using NK-staplers (45 mm ×2), followed by a Lembert anastomosis covering the stapler's suture lines. Results: They were discharged on the ninth and seventh postoperative days, respectively. In Case 1, we experienced recanalization of the fistula after three postoperative months and required second closure with the same procedure was needed. They have not experienced any symptoms of ENF since. Conclusions: This technique is worth considering for the surgical treatment of ENF because it does not require unnecessary dissection and can ultimately achieve fistula closure. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to present our laparoscopic cystectomy experience and demonstrate that it is a feasible technique with safe oncologic principles. Methods: Total 19 patients who underwent laparoscopic radical cystectomy and pelvic lymph node dissection (PLND) in our urology clinic (Okmeydani Training and Research Hospital) were retrospectively evaluated. Demographic data, operation technique and complications, tumour pathology and follow-up details of patients were recorded. Results: Patients ranged from 40 to 73 years, with the average age of 60.8 and female/male rate was 2/17. The mean total operation time was 375 min (range 260–500). Mean hospitalisation time of patients was 10.3 days. The mean follow-up time was 11.2 months. Conclusion: Minimally invasive approaches in urology are becoming the first line treatment by the time. Due to the high costs and limited availability, robotic surgery is still not exactly widespread in the world. Our series showed that conventional laparoscopic cystectomy is an appropriate approach until robotic surgery becomes widespread. [ABSTRACT FROM AUTHOR]

The mortality after radical cystectomy with urinary diversion has been reduced from 11% in 53 patients operated on during 1971-78, to 2.5% in a similar group of 120 patients operated on during 1978-85. Amongst the latter, mortality varied from 0 amongst 32 non-irradiated patients, to 1 (3%) of 33 after planned preoperative radiotherapy and 2 (3.6%) of 55 after previous radical radiotherapy. The improvement in results appears to be due to a number of factors including routine intensive care in the early postoperative phase, with epidural analgesia, and meticulous attention to haemostasis and the technical details of construction of the ileal conduit. [ABSTRACT FROM AUTHOR]