Open Access

ARTICLE

Is mesenteric defect closure needed in urologic surgery using ileum?

Michael A. Avallone, Peter N. Dietrich, Shanta T. Shepherd, Mona Lalehzari, R. Corey O’Connor, Michael L. Guralnick

Department of Urology, Medical College of Wisconsin. Milwaukee, Wisconsin, USA
Address correspondence to Dr. Michael L. Guralnick, Dept. of Urologic Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226 USA

Canadian Journal of Urology 2018, 25(3), 9334-9339.

Abstract

Introduction: Classic surgical teaching advocates for closure of the mesenteric defect (MD) after bowel anastomosis, but the necessity is controversial. We sought to evaluate the necessity of MD closure at the time of harvest of ileum for genitourinary reconstructive surgery (GURS) by analyzing the incidence of early and late gastrointestinal adverse events (GIAE) in patients with and without MD closure.
Materials and methods: A retrospective review was conducted on patients undergoing urologic reconstruction with ileum to identify incidence of ileus, small bowel obstruction (SBO), gastrointestinal (GI) fistula, and stoma complications. Patient and procedure variables were analyzed to identify risk factors for GIAE.
Results: A total of 288 patients met inclusion criteria, and 93% of GURS was for urinary diversion following cystectomy. MD was closed in 194 cases (67%). Median follow-up was 19 months. Early (< 30 days) GIAE rates were 16.5% (n = 32) and 21.3% (n = 20) in the closure and non-closure groups, respectively (p = 0.22). The rate of early ileus/SBO requiring nasogastric tube decompression or laparotomy were similar after closure (15.0%) and non-closure (21.3%) (p = 0.18). The late GIAE rates were 5.7% (n = 11) and 6.4% (n = 6) in the closure and non-closure cohorts, respectively (p = 0.56). The rate of late SBO was similar, and no cases of early or late SBO in either cohort were due to internal herniation. On multivariate analysis, increasing BMI was associated with both early and late GIAE.
Conclusions: After harvesting ileum for urologic reconstruction, the MD can safely be left open as we found no association between non-closure and early or late GIAE.

---

Keywords

---