Mini-laparotomy radical cystectomy with limited bowel externalization during ileal conduit urinary diversion reduces the rate of postoperative complications: a match-paired, single centered analysis

Abstract

Objective

To assess the feasibility and functional outcomes of mini-laparotomy radical cystectomy (RC) in association with limited bowel externalization during ileal conduit urinary diversion.

Methods

Between January 2018 and March 2020, 53 patients underwent RC plus pelvic lymph node dissection (PLND) for invasive carcinoma of the urinary bladder. This group of patients was intentionally treated utilizing the mini-laparotomy approach, with the addition of limited bowel externalization during conduit preparation and match-paired with 46 examinees from a historical series of patients who underwent conventional open RC plus PLND and ileal conduit diversion. Clinicopathological features and perioperative outcomes were examined from medical records, while postoperative pain was evaluated through the Visual Analog Scale for Pain (VAS). Mean pain scores were evaluated on postoperative days (POD) 1–3.

Results

There was no difference in specific intraoperative complications between groups, with a median (range) incision length of 8 (5–10) cm within the first group and 16.3 (12–22.6) cm within the second group. The first group had less postoperative pain compared with patients in the second group, with mean pain scores significantly lower across POD 1–3, 3.8 (IQR: 0–6) versus 6.7 (IQR: 3.8–8.1) and 2.5 (IQR: 1–3.7) versus 4.6 (IQR: 3–6), respectively (p = .012 and .002).

Conclusions

By using this technique, we were able to significantly reduce patients’ postoperative pain, time to bowel restitution, and hospital stay, which are major issues in minimizing short-term postoperative complications of conventional open surgery.

Keywords:

• Cystectomy
• ileal conduit
• mini-laparotomy
• bowel manipulation
• perioperative complications

Ethical approval

Each subject signed the acceptance of the study protocol, in which the Ethical Principles for Medical Research Involving Human Subjects (The Helsinki Declaration) were clearly stated.

Disclosure statement

No potential conflict of interest was reported by the authors.