THE STAPLED CONTINENT ILEOCECAL URINARY RESERVOIR IN THE SURGICAL-MANAGEMENT OF GYNECOLOGIC MALIGNANCY

Total cystectomy at the time of radical pelvic surgery for gynecologic malignancies is not uncommon. Many techniques have been developed for urinary diversion including the continent ileocecal urinary reservoir . Twenty-nine patients underwent construction of a continent ileocecal urinary reservoir during the reconstructive phase of an exenterative procedure or for the relief of urinary tract fistula between 1990 and 1993. Ah procedures were performed using the mechanical stapling devic es using metal staples. The right and proximal transverse colon were m obilized to a length of 24 cm. The ileum was divided 8 cm proximal to the ileocecal valve and plicated using the stapling technique. The col onic segment was opened on its antimesenteric border and the reservoir was created by stapling in a fashion to reapproximate the distal ends to each other. The ureters were stented and implanted without tunneli ng. A large Malecot drain was placed in all the pouches for irrigation of the colonic mucosa in the postoperative period. The ileal stoma wa s fixed to the anterior abdominal wall as was the anterior surface of the pouch. Operative time ranged from 50 to 150 min for the pouch cons truction. All patients underwent retrograde contrast study of the pouc h 7-10 days postoperatively to verify lack of anastomatic leaks. After recovery, all patients successfully self-catheterized the pouch three to five times daily without difficulty. Of the 29 patients, 17 (59%) had received prior radiation as part of therapy. Ah patients remained continent at the end of observation. One developed a fistula to the pe rineum after intraoperative placement of I-125 seeds on the pelvic wal l. One patient developed pouch stones; endoscopic evaluation of this p ouch revealed no evidence of stones at the staple lines and metabolic workup demonstrated hypocitremia as the etiology for the stones. Mean reservoir volume was 550 ml. Mean follow-up is 15.8 months; 5 have exp ired due to recurrent disease and 19 (83%) remain alive, Only two pati ents have been admitted for urosepsis due to reflux pyelonephritis. Th e stapled continent ileocecal reservoir offers benefits to patients un dergoing total cystectomy. Using the mechanical stapling devices decre ases the operative time and has not resulted in stone formation or pou ch leakage. The complications of the procedure are acceptable. (C) 199 4 Academic Press, Inc.