Posterior conduit fixation with retroperitonealization of uretero-ileal anastomosis after open radical cystectomy reduces the postoperative complication rate: a retrospective, matched-paired single-center analysis.

Abstract

Background: Our study aimed to assess the efficacy of posterior conduit fixation with retroperitoneal ureteroileal anastomosis (UIA) in reducing perioperative complications after radical cystectomy (RC) with ileal conduit (IC) urinary diversion.

Methods: We conducted a retrospective case-control study, including 150 patients who underwent either modified IC technique (extraperitonealized anastomosis with posterior conduit fixation; n = 79) or the conventional IC technique (n = 71). The primary endpoints were the incidence of clinical parastomal hernia (PSH) and ileus. Secondary endpoints included operative time, postoperative complication rates, and length of hospital stay (LOS). Multivariate logistic regression was performed to identify predictors of early and late stoma- related complications.

Results: The modified group showed significantly lower incidence of both early and late postoperative complications, including ileus and PSH, compared to the conventional group (8.86% vs. 28.1%, p = 0.01 and 7.6% vs. 17%, p = 0.03, respectively) after a median follow-up of 34 months. Corresponding hazard ratios were 0.312 (95% CI: 0.047-0.798, p = 0.01) for early complications and 0.267 (95% CI: 0.105-0.611, p = 0.03) for late complications.

Conclusion: The results support our hypothesis that extraperitoneal ureteroileal anastomosis combined with posterior conduit fixation effectively reduces the risk of both early and late postoperative complications, including parastomal hernia and ileus.