67th Annual Meeting Abstracts
Novel Reconstructive Repair Of Ileal Loop Stomal Stenosis Or Left Ureteroileal Anastomotic Stricture With A New Segment Of Ileum
*Alan O. Kusakabe, Toby C Chai
University of Maryland Baltimore, Baltimore, MD
Introduction:Creation of an ileal loop urinary conduit can be complicated by stomal stenosis and left ureteral stricture. These complications can be difficult to manage, especially for left ureteroileal anastomotic stictures since primary re-anastomosis may be impossible due to insufficient ureteral length. Reconstruction with another segment of ileum can treat these complications.
Materials & Methods:Two patients with stomal stenosis and concomitant parastomal hernia underwent repair. The order of the surgery was: exploratory laparotomy, takedown of urostomy, excision of the stomal stenosis, repair of the parastomal hernia, harvest of a new ileal segment, re-establishment of bowel continuity, end-to-end ileoileostomy (old loop to new loop) and maturation of new stoma on contralateral abdominal wall. We coined this repair an “extend-a-loop”. Three other patients with left uretero-ileal anastomotic ureteral strictures (between 2-8 cm in length) had reconstruction by harvesting a new ileal segment, re-establishment of bowel continuity, anastomosing the patent proximal left ureter to the new ileal segment, and performing end-to-side ileoileostomy (old to new loop).
Results:Both patients with stomal stenosis have functional, viable stomas with a minimum of 24-months followup. The 3 patients with left ureteral reconstruction have unobstructed left ureters between 6 months to 5 years followup.
Conclusions: Surgical management of stomal stenosis or left ureteral stenosis after ileal loop urinary conduit is technically complex. Reconstruction with additional ileal segment is an option with excellent outcomes. A caveat is that extensive operative dissection (complete enterolysis and left retroperitoneal exploration) is required and the urologist has to be prepared for this.
