Double-barrel wet colostomy after total pelvic exenteration

Lago, Víctor; Marina, Tiermes; Oliva, F.J. Delgado; Padilla-Iserte, Pablo; Matute, Luis; Domingo, Santiago

doi:10.1136/ijgc-2019-000993

Cited by 3 publications

(4 citation statements)

References 3 publications

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“…Rates of infective complications following DBUC vary considerably in the literature, and may be as high as 50% for early UTI and 60% for recurrent UTI 16 . In our series, 20% of patients developed early UTI/urosepsis ( n = 4) and 20% late UTI/recurrent urosepsis ( n = 4), which is lower than rates reported in the literature 16,17 …”

Section: Discussioncontrasting

confidence: 56%

“…16 In our series, 20% of patients developed early UTI/urosepsis (n = 4) and 20% late UTI/recurrent urosepsis (n = 4), which is lower than rates reported in the literature. 16,17 When comparing our cohort (n = 20) to Nguyen et al's prospective series from the Royal Adelaide Hospital Pelvic Exenteration Service (n = 16), our cohort experienced lower rate of ureteric stricture (10.0 versus 25.0%), urinary leak (0.0 versus 6.3%) and urosepsis (20.0 versus 43.8%), slightly higher incidence of postoperative acute kidney injury (40.0 versus 31.3%) and similar rate of parastomal hernia requiring repair (5.0 versus 6.3%). 12 Our cohort had longer mean follow up duration (29.1 versus 18.0 months), higher rates of lateral pelvic lymph node dissection (77.8 versus 25%) and bone resection (40.0 versus 18.8%), and similar rates of prior radiotherapy (90.0 versus 93.8%).…”

Section: Discussionmentioning

confidence: 99%

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A single centre experience on the formation of double barrelled uro‐colostomy in pelvic exenteration surgery: a cohort study

Limmer,

Lendzion,

Leung

et al. 2024

ANZ Journal of Surgery

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BackgroundDouble barrelled uro‐colostomy (DBUC) is an alternative to traditional ileal conduit (IC) and separate colostomy in patients requiring simultaneous urinary and faecal diversion for reconstruction in pelvic exenteration surgery (PES).MethodsThis cohort study evaluated short‐ and long‐term morbidity and mortality associated with DBUC formation in 20 consecutive adult patients undergoing PES in an Australian Complex Pelvic Surgical Unit. Data were obtained from a prospective database.ResultsMean age 59 years (range 27–76 years). PES was performed for malignant disease in 18 patients (curative intent in 17). Mean operative duration 11.8 h (range 7–17 h). Mean follow‐up duration 29.1 months (range 2.6–90.1 months). Early DBUC‐related complications occurred in four patients (20.0%): urinary tract infection (UTI)/urosepsis (n = 4) and early ureteric stenosis requiring intervention (n = 1). Late DBUC‐related complications occurred in five patients (25.0%): recurrent UTI/urosepsis (n = 4), chronic kidney disease (n = 4), ureteric stenosis (n = 2) and parastomal hernia (n = 4). No mortality occurred secondary to a DBUC complication.ConclusionDBUC is a safe reconstructive option with acceptable morbidity profile in patients requiring simultaneous urinary and faecal diversion.

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Section: Discussioncontrasting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

A single centre experience on the formation of double barrelled uro‐colostomy in pelvic exenteration surgery: a cohort study

Limmer,

Lendzion,

Leung

et al. 2024

ANZ Journal of Surgery

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“…Since June 2017, there has also been increased adoption of double barrel uro‐colostomies in selected patients 19 . This method of diversion benefits patients by having a single stoma appliance, and avoiding an additional small bowel anastomosis, as would be required for separate ileal conduit urinary diversion 19,20 . This technique is becoming increasingly popular for these reasons, and may have contributed to the reduction in major complications seen in our study.…”

Section: Discussionmentioning

confidence: 77%

“…19 This method of diversion benefits patients by having a single stoma appliance, and avoiding an additional small bowel anastomosis, as would be required for separate ileal conduit urinary diversion. 19,20 This technique is becoming increasingly popular for these reasons, and may have contributed to the reduction in major complications seen in our study. Notably, there was a significantly lower rate of urinary sepsis recorded after 2017.…”

Section: Discussionmentioning

confidence: 83%

Short‐term outcomes following development of a dedicated pelvic exenteration service in a tertiary centre

Traeger

Bedrikovetski

Oehler

et al. 2022

ANZ Journal of Surgery

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Background: Pelvic exenteration surgery (PE) offers potentially curative resection for locally advanced malignancy but is associated with significant complexity and morbidity. Specialised teams are recommended to achieve optimal patient outcomes. This study aims to analyse short-term outcomes at a tertiary setting before and after creating a dedicated PE service. Methods: Patients undergoing PE between 2008 and October 2021 at the Royal Adelaide Hospital and St. Andrews Hospital in South Australia were included, with prospective data collection since June 2017. Patients operated on prior and post the creation of the PE service were compared via univariate analyses. Results: In total, 113 patients were included, with a significant increase in volume of cases post creation of the PE service, (n = 46 pre versus n = 67 post). There were significant differences in the type of neoadjuvant therapy and patient co-morbidity, with more advanced disease stage and a higher likelihood of bone involvement (P < 0.05) in the latter period. An increased proportion of patients had flap reconstruction (40.3 versus 33.9%, P = 0.010) as well as lateral lymph node dissection (13.4 versus 2.2%, P = 0.046). Despite this, perioperative outcomes such as urosepsis (11.9 versus 28.3%, P = 0.028) and Clavien-Dindo grade of complications grade improved. R0 resections were achieved in 93.9% of curative cases (93.9 versus 84.2%, P = 0.171). Conclusion:The development of a PE service significantly improved short term patient outcomes, despite the inclusion of patients with more advanced disease and comorbidity.

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Urinary diversion after pelvic exenteration for gynecologic malignancies

Martínez-Gómez

Ángeles

Martinez

et al. 2021

International Journal of Gynecological Cancer

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Pelvic exenteration combines multiple organ resections and functional reconstruction. Many techniques have been described for urinary reconstruction, although only a few are routinely used. The aim of this review is to focus beyond the technical aspects and the advantages and disadvantages of each technique, and to include a critical analysis of continent techniques in the gynecologic and urologic literature. Selecting a technique for urinary reconstruction must take into account the constraints entailed by the natural history of the disease, patient characteristics, healthcare institution, and surgeon experience. In gynecologic oncology, the Bricker ileal conduit is the most commonly employed diversion, followed by the self-catheterizable pouch and orthotopic bladder replacement. Continent and non-continent diversions present similar immediate and long-term complication rates, including lower tract urinary infections and pyelonephritis (5–50%), ureteral stricture (3–27%), urolithiasis (5–25%), urinary fistula (5%), and more rarely, vitamin B12 deficiency and metabolic acidosis. Urinary incontinence for the ileal orthotopic neobladder (50%), stoma-related complications for the Bricker ileal conduit (24%), difficulty with self-catheterization (18%) for the continent pouch, and induction of secondary malignancy for the ureterosigmoidostomy (3%) are the most relevant technique-related complications following urinary diversion. The self-catheterizable pouch and orthotopic bladder require a longer learning curve from the surgical team and demand adaptation from the patient compared with the ileal conduit. Quality of life between different techniques remains controversial, although it would seem that young patients may benefit from continent diversions. We consider that centralization of pelvic exenteration in referral centers is crucial to optimize the oncologic and functional outcomes of complex ablative reconstructive surgery.

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Double-barrel wet colostomy after total pelvic exenteration

Cited by 3 publications

References 3 publications

A single centre experience on the formation of double barrelled uro‐colostomy in pelvic exenteration surgery: a cohort study

A single centre experience on the formation of double barrelled uro‐colostomy in pelvic exenteration surgery: a cohort study

Short‐term outcomes following development of a dedicated pelvic exenteration service in a tertiary centre

Urinary diversion after pelvic exenteration for gynecologic malignancies

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