Bowel complications and anastomotic leak after ileocolic anastomosis in urinary diversion surgery: a comparative 12-year retrospective single-center study.

Background: There is limited data within the urologic literature regarding bowel complications and leak rates following surgery requiring ileocolic anastomoses such as right colon pouch (RCP) and continent cutaneous ileocecocystoplasty (CCIC). We aimed to establish ileocolic anastomotic leak rates in urologic reconstructive surgery and determine bowel-related complications following RCP and CCIC surgeries.

Methods: We reviewed adult patients who underwent RCP or CCIC (2010-2022), investigating patient characteristics, perioperative variables, and outcomes. We used Cox Proportional Hazards analysis to compare bowel-related complications. Patients with proximal ileostomy were excluded from analysis, as well as those with less than 90 days follow-up.

Results: Of 162 patients, 106 (65.4%) underwent RCP and 56 (34.6%) underwent CCIC. The mean age was 55.5 (13.1) and 40.3 (14.6) years in RCP and CCIC group (P<0.001). The leading etiology was radiation injury [34 (32.1%)] and spinal cord injury [32 (57.1%)] for RCP vs. CCIC. In the RCP group, there were 46 (43.4%) patients readmitted within 90 days and 12 (20.7%) in the CCIC group, (P=0.01). Survival, at a median follow-up of 30 (10.3-66.6) months, was 82.1% and 87.5% in the RCP vs. CCIC group (P=0.37). Anastomotic leak occurred in 8 (7.5%) patients in the RCP and 2 (3.6%) patients in the CCIC group (P=0.32). Notably, we found that the type of anastomosis, stapled reinforced lines compared to single-layered (hand sewn or stapled), significantly influenced both bowel complications [hazard ratio (HR): 0.1; 95% confidence interval (CI): 0.03-0.33] and anastomotic leaks (HR: 0.17; 95% CI: 0.04-0.75). There were no significant differences in bowel complications (HR: 0.6, 95% CI: 0.15-2.4) or anastomotic leaks (HR: 0.38, 95% CI: 0.06-2.21) between RCP and CCIC groups.

Conclusions: This study establishes ileocolic anastomotic leak rates in a large urologic patient population. Our findings highlight the protective role of double-layered ileocolic anastomosis reinforced with hand-sewn sutures in reducing bowel complications and anastomotic leaks. There were no significant distinctions between RCP and CCIC in survival rates and bowel complications.