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Multimodal perioperative plan for radical cystectomy and intestinal urinary diversion. I. Effect on recovery of intestinal function and occurrence of complications.
Urology 2007; 69(6):1107-11U

Abstract

OBJECTIVES

To discuss a multimodal perioperative plan aimed at reducing postoperative ileus and complications associated with radical cystectomy and urinary reconstruction.

METHODS

The protocol consisted of preoperative, intraoperative, and postoperative measures. The clinical parameters assessed were the time to the return of bowel movements, the presence and duration of postoperative ileus, the presence and duration of an intolerance to oral feeding, the interval to re-institution of a regular diet, and complications. The biochemical parameters (serum total protein and albumin levels and lymphocyte counts) were also assessed. A sample of 40 patients treated before the implementation of this protocol was included for comparison.

RESULTS

A total of 71 patients, mean age 74 years and American Society of Anesthesiologists status 2 and 3, consecutively underwent radical surgery for bladder cancer and were evaluable for results and complications. Urinary diversion was a heterotopic neobladder in 27 patients (38%), orthotopic in 23 (32.3%), and an ileal conduit in 21 (29.5%). Bowel movements returned after a median of 2 days (range 1 to 6), intolerance to oral feeding was observed in 17 (23.9%) of 71 patients, and the median time to re-institution of a regular diet was 4 days (range 3 to 9). The complication rate was 26.7%, and the mortality rate was 4.2%. No effects were observed on postoperative protein depletion. In the historical group, the median time to diet resumption was 8 days (range 7 to 12).

CONCLUSIONS

A short time to the resumption of normal intestinal function and a low incidence of postoperative ileus after cystectomy was observed. However, the incidence of postoperative protein depletion was unaffected. Additional studies should address this subject.

Authors+Show Affiliations

Struttura Complessa di Urologia, E.O. Ospedali Galliera, Genova, Italy. massimo.maffezzini@galliera.itNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17572196

Citation

Maffezzini, Massimo, et al. "Multimodal Perioperative Plan for Radical Cystectomy and Intestinal Urinary Diversion. I. Effect On Recovery of Intestinal Function and Occurrence of Complications." Urology, vol. 69, no. 6, 2007, pp. 1107-11.
Maffezzini M, Gerbi G, Campodonico F, et al. Multimodal perioperative plan for radical cystectomy and intestinal urinary diversion. I. Effect on recovery of intestinal function and occurrence of complications. Urology. 2007;69(6):1107-11.
Maffezzini, M., Gerbi, G., Campodonico, F., & Parodi, D. (2007). Multimodal perioperative plan for radical cystectomy and intestinal urinary diversion. I. Effect on recovery of intestinal function and occurrence of complications. Urology, 69(6), pp. 1107-11.
Maffezzini M, et al. Multimodal Perioperative Plan for Radical Cystectomy and Intestinal Urinary Diversion. I. Effect On Recovery of Intestinal Function and Occurrence of Complications. Urology. 2007;69(6):1107-11. PubMed PMID: 17572196.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Multimodal perioperative plan for radical cystectomy and intestinal urinary diversion. I. Effect on recovery of intestinal function and occurrence of complications. AU - Maffezzini,Massimo, AU - Gerbi,Guido, AU - Campodonico,Fabio, AU - Parodi,Donatella, PY - 2006/02/13/received PY - 2007/01/15/revised PY - 2007/02/27/accepted PY - 2007/6/19/pubmed PY - 2007/8/30/medline PY - 2007/6/19/entrez SP - 1107 EP - 11 JF - Urology JO - Urology VL - 69 IS - 6 N2 - OBJECTIVES: To discuss a multimodal perioperative plan aimed at reducing postoperative ileus and complications associated with radical cystectomy and urinary reconstruction. METHODS: The protocol consisted of preoperative, intraoperative, and postoperative measures. The clinical parameters assessed were the time to the return of bowel movements, the presence and duration of postoperative ileus, the presence and duration of an intolerance to oral feeding, the interval to re-institution of a regular diet, and complications. The biochemical parameters (serum total protein and albumin levels and lymphocyte counts) were also assessed. A sample of 40 patients treated before the implementation of this protocol was included for comparison. RESULTS: A total of 71 patients, mean age 74 years and American Society of Anesthesiologists status 2 and 3, consecutively underwent radical surgery for bladder cancer and were evaluable for results and complications. Urinary diversion was a heterotopic neobladder in 27 patients (38%), orthotopic in 23 (32.3%), and an ileal conduit in 21 (29.5%). Bowel movements returned after a median of 2 days (range 1 to 6), intolerance to oral feeding was observed in 17 (23.9%) of 71 patients, and the median time to re-institution of a regular diet was 4 days (range 3 to 9). The complication rate was 26.7%, and the mortality rate was 4.2%. No effects were observed on postoperative protein depletion. In the historical group, the median time to diet resumption was 8 days (range 7 to 12). CONCLUSIONS: A short time to the resumption of normal intestinal function and a low incidence of postoperative ileus after cystectomy was observed. However, the incidence of postoperative protein depletion was unaffected. Additional studies should address this subject. SN - 1527-9995 UR - https://www.unboundmedicine.com/medline/citation/17572196/Multimodal_perioperative_plan_for_radical_cystectomy_and_intestinal_urinary_diversion__I__Effect_on_recovery_of_intestinal_function_and_occurrence_of_complications_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0090-4295(07)00292-0 DB - PRIME DP - Unbound Medicine ER -