膀胱全切除術中輸尿管與迴腸吻合置於乙狀結腸前方之初步經驗

吳志緯¹、何承勳¹

1. 新光吳火獅紀念醫院外科部泌尿科

The Initial Experience of Uretero-Ileal Anastomosis Anterior to Sigmoid Colon During Radical Cystectomy

Chih-Wei Wu ¹, Chen-Hsun Ho ¹

1.Divisions of Urology, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan

Purpose:

Urinary diversion is the major source of complications of radical cystectomy. The conventional retrosigmoid route for left ureter transposition requires extensive mobilization and may cause ischemia or compression by the sigmoid mesentery, leading to stricture. We herein reported our initial experience of a modified approach performing uretero-ileal anastomosis anterior to the sigmoid colon.

Materials and Methods:

From 2024 to 2025, six consecutive patients with muscle-invasive urothelial carcinoma underwent robotic-assisted radical cystectomy with ileal conduit urinary diversion using this modified technique. All surgeries were performed by a single surgeon following an enhanced recovery protocol. After bladder removal and extended lymph node dissection, a 20–25 cm ileal segment was isolated approximately 20 cm proximal to the ileocecal valve. The conduit was constructed extracorporeally via a 6–8 cm midline incision using Bricker's technique. Both ureters were anastomosed to the ileal segment anterior to the sigmoid colon with minimal dissection at their native positions. Postoperative monitoring included operative metrics, bowel recovery, renal function, and complications. The study protocol was approved by the local institutional review board.

Results:

All procedures were completed without intraoperative complications or conversion. Median operative time was 402 minutes (343 to450 mins), and median blood loss was 467 mL (200 to 900 mL). Gastrointestinal recovery was prompt; the median time of flatus passage was 2.5 days (range 2 to 3 days). None developed ileus during the followup. Median time of hospital stay was 10 days (9 to14 days). Renal function remained stable in all cases, and none had hydronephrosis during the followup.

Conclusion:

Uretero-ileal anastomosis anterior to the sigmoid colon offers a safe and technically straightforward modification of ileal conduit reconstruction. By minimizing ureteral dissection and avoiding mesenteric compression, this approach may reduce stricture formation and preserve renal function. Early outcomes from this pilot series are encouraging, warranting validation in a larger cohort with longer followup.