Bricker versus Wallace anastomosis: A meta-analysis of ureteroenteric stricture rates after ileal conduit urinary diversion

Abstract

Introduction: Data comparing the incidence of ureteroenteric strictures for Bricker and Wallace anastomoses are limited. This study compares both anastomotic techniques in terms of ureteroenteric stricture rates after radical cystectomy and ileal conduit urinary diversion. Methods: Electronic databases (Medline, EMBASE, and Cochrane database) were searched for studies comparing Bricker and Wallace ureteroeneteric anastomoses for ileal conduit urinary diversion after radical cystectomy. Meta-analyses were performed using the random effects method. The primary outcome measure was to determine differences in postoperative ureteroenteric stricture rates for both surgical techniques. Four studies describing 658 patients met the inclusion criteria. The total number of ureters used for ureteroeneteric anastomoses was 1217 (545 in the Bricker group and 672 in the Wallace group). Results: There were no significant differences in age (p = 0.472), gender (p = 0.897), duration of follow-up (p = 0.168), and duration to stricture development between groups (p = 0.439). The overall stricture rate was 29 of 1217 (2.4%); 16 of 545 ureters (2.9%) in the Bricker group and 13 of 672 ureters (1.9%) in the Wallace group. The Bricker anastomosis was not associated with a significantly higher overall stricture rate compared to the Wallace ureteroenteric anastomosis (odds ratio: 1.393, 95% confidence interval: 0.441-4.394, p = 0.572).

Ureteroenteric strictures: a single center experience comparing Bricker versus Wallace ureteroileal anastomosis in patients after urinary diversion for bladder cancer

“…Of the eligible, published studies, one meta-analysis by Davis et al has summarized the most relevant issues when Bricker and Wallace techniques are compared [10]. In this analysis, they included a prospective trial conducted by Liu et al, that did not find one technique to be superior to the other [11].…”

Getting out of a tight spot: an overview of ureteroenteric anastomotic strictures

“…Knap et al 16 reported that the risk of ureteroenteric strictures was significantly higher in patients with a history of pelvic radiotherapy than in those without. This associ ation, however, has not been supported by larger studies 4,8,13,17,20,21 , although a reduced success rate of stricture repair has been reported in patients with a history of pelvic radiotherapy 22 . This evidence highlights the importance of choosing a viable segment of ileum outside the confines of the irradiated field 19 .…”

“…2). The Bricker and Wallace techniques are the two most common ways to create a refluxing anastomosis 4 . With the Bricker technique, each ureter is spatulated and implanted separately to the conduit with full-thickness interrupted or running absorbable sutures, forming an end-to-side anastomosis (FIG.…”

Urinary Diversion in the Elderly

“…In this study, literature cited in Medline, EMBASE, and Cochrane database was reviewed with extraction of a total of 658 patients totaling 1217 anastomosis (545 Bricker vs. 672 Wallace). The evaluators found that although the rate of stricture formation was 2.9 and 1.9 % for the Bricker and Wallace groups; however, the difference was not statically significant with an OR of 1.39 (0.441-4.394, p=0.572) [33].…”