Fast-track surgery and technical nuances to reduce complications after radical cystectomy and intestinal urinary diversion with the modified Indiana pouch

Objectives: With the purpose to reduce the complications of radical cystectomy and intestinal urinary reconstruction a perioperative protocol based on fast-track surgery principles and technical modifications of the original surgical technique was applied to patient candidates for etherotopic bladder substitution. Our protocol included pre-, intra-, and postoperative interventions. The technical variations of the modified Indiana pouch technique were focused on intestinal anastomosis to restore bowel continuity, uretero-colonic anastomoses, and capacity of the reservoir. Results and limitations: From 2003 to 2010, 68 consecutive patients participated in the study. Two patients died due to surgical complications (2.9%). Overall, 24 of 68 patients experienced complications (35.3%). Surgery was needed under general anaesthesia for seven patients (10.2%) and under local anaesthesia for four (5.9%). Medical complications were encountered in 13 of 68 patients (19.1%). According to Clavien grading, complications were grade 5 in two patients, grade 4 in two patients, grade 3b in five patients, grade 3a in four patients, grade 2 in nine patients, and grade 1b in two patients. A limitation of our series is that patients were recruited at a single urologic centre and were operated by a single surgeon. Findings need validation. Conclusions: Progress in the perioperative management of major surgery and technical refinements can contribute to reduced complications. In addition, the use of objective reporting tools will facilitate comparison of studies. (C) 2012 Elsevier Ltd. All rights reserved.