Abstract
Introduction:
Delay in returns of bowel function can impact outcomes in cystectomy with ileal conduit. In this series, we introduce a novel iso-peristaltic intracorporeal ileal-ileal anastomosis technique that preserves native peristaltic direction, potentially improving postoperative return of bowel function.
Patient Demographic and Postoperative Outcomes
| Parameter | Value |
|---|---|
| Number of patients | 12 |
| Number of men (%) | 6 (50%) |
| Mean age (SD) | 67.2 (5.2) |
| Mean BMI (SD) | 27.5 (1.1) |
| Mean hours operative time (SD) | 8.8 (0.7) |
| Mean first day of flatus (SD) | 3.2 (1.0) |
| Mean day of first bowel movement (SD) | 3.5 (1.0) |
| Mean days length of stay (SD) | 6.8 (2.5) |
| Number dx with Ileus (%) | 3 (25%) |
| Number with readmission <30 days (%) | 0 (0%) |
| Number with reoperation <30 days (%) | 0 (0%) |
SD, standard deviation; %, proportion.
Methods:
The outcomes of all patients undergoing iso-peristaltic restoration of bowel in a single surgeon practice between October 2024 and June 2025 were reported. We demonstrate the iso-peristaltic technique as performed during robot-assisted radical cystectomy with ileal conduit in one patient. Key steps include ileal conduit dissection, orientation of the proximal and distal ileal segments, staple anastomosis of the bowel segments, and closure of the enterotomies using a running Canal stich. The accompanying video outlines port placement, segment isolation, bowel orientation, and anastomosis creation.
Results:
A total of 12 patients underwent iso-peristaltic restoration of bowel (Table 1). Average age was 66.8 ± 5.2 (standard deviation) years, BMI 27.5 ± 1.1 kg/m2, and operative time was about 8.8 ± 0.7 hours. The mean first day of flatus was 3.2 ± 1.0 days, first bowel movement 3.5 ± 1.0 days, and mean length of stay 6.8 ± 2.5 days. Only three patients were diagnosed with an ileus. No patients underwent readmissions or revision procedures within 30 days of their procedure.
Conclusions:
Isoperistaltic intracorporeal ileal-ileal anastomosis is a safe technique that should be considered during cystectomy with ileal conduit creation. The approach can be completed both openly and robotically with a variety of staplers (hand-held, robotic, etc). Further study is necessary to evaluate the potential benefits for the restoration of bowel function when utilizing the isoperistaltic versus antiperistaltic approach.
Author(s) have received and archived patient consent for video recording/publication in advance of the video recording of the procedure.
The authors disclose that they have no commercial associations that might create a conflict of interest in connection with this video.
Runtime of video: 7 mins 4 secs.