Role of bowel suspension technique to prevent early intestinal obstruction after radical cystectomy with ileal orthotopic neobladder: A retrospective cohort study

Objective: We investigate the impact of the bowel suspension technique (BST) on paralytic ileus and early intestinal obstruction (<= 60days) after radical cystectomy (RC) with ileal orthotopic neobladder (IONB). Methods: We retrospectively reviewed 310 patients who underwent RC with IONB for bladder cancer between 2001 and 2017. After forming the Studer IONB, ileal continuity was restored by side-to-side stapled anastomosis. Then, we suspended stapled anastomotic portion of bowel on the posterior peritoneum not to fall into the pelvic cavity. The clinicopathologic characteristics of patients were examined and the onset of paralytic ileus and early intestinal obstruction were identified. Logistic regression analysis was used to identify predictors associated with paralytic ileus and early intestinal obstruction. Results: Of the 310 total patients, paralytic ileus and early intestinal obstruction were identified in 100 (32.3%) and 15 (4.8%), respectively. When patients were divided into two groups (BST [-] vs. BST [+]), the rates of paralytic ileus were not significantly different (64/205[31.2%] vs. 36/105[34.3%], P=0.585). However, early intestinal obstruction that required surgical treatment was significantly decreased (14/205[6.8%] vs. 1/105[1.0%], P=0.024). On multivariate analysis, older age was commonly associated with paralytic ileus and early intestinal obstruction (P=0.008 and P=0.016). BST was inversely associated with early intestinal obstruction (95% CI: 0.01-0.85, P=0.034), but not related to paralytic ileus. Conclusion: BST significantly reduced early intestinal obstruction without increasing paralytic ileus after RC with IONB. BST could be used as useful technique to reduce severe bowel complications.