Laparoscopic enterocystoplasty

Abstract

Objectives: To report the initial clinical experience with laparoscopic augmentation enterocystoplasty using the ileum, sigmoid, or right colon.

Methods: Three patients with functionally reduced bladder capacities due to neurogenic causes underwent laparoscopic enterocystoplasty: ileocystoplasty (n = 1), sigmoidocystoplasty (n = 1), and cystoplasty with cecum and proximal ascending colon (n = 1). In the last patient, a continent, catheterizable, ileal conduit with an umbilical stoma was also created. In all patients, bowel reanastomosis was performed by exteriorizing the bowel loop outside the abdomen through a 2-cm extension of the umbilical port site. Creation of a large cystotomy, mobilization of the appropriate bowel segment, and the circumferential enterovesical anastomosis were all performed intracorporeally by laparoscopic techniques.

Results: The operative times were 5.3, 8, and 7 hours. All three laparoscopic enterovesical anastomoses were watertight, without postoperative urinary extravasation. The hospital stay was 7, 5, and 4 days.

Conclusions: Laparoscopic enterocystoplasty is feasible, safe, and efficacious and appears to be an attractive alternative to open enterocystoplasty. Various bowel segments can be used as with open surgery, including creation of a continent, catheterizable stoma. Although further technical refinements will undoubtedly occur, even at this early stage, it is clear that the technical steps of an enterocystoplasty can be satisfactorily and effectively performed laparoscopically.