Extra-Peritoneal versus Trans-Peritoneal Open Radical Cystectomy - Comparison of Two Techniques in Early Post-Operative Complications.

The conventional Trans-Peritoneal Radical Cystectomy (TPRC) harbors numerous postoperative complications, the most prevalent of which are Gastrointestinal (GI) problems. To reduce these morbidities we introduced our own version of extra-peritoneal approach and compared it with the conventional method.   Materials and Methods: In a cross-sectional observational retrospective design, eligible bladder cancer patients whom underwent Extra-Peritoneal Radical Cystectomy (EPRC) or TPRC in our center, were considered for this study and were compared for early post-operative complications .

Ninety nine patients in TPRC and 81 in EPRC were compared. The two techniques differed in their mean operation time (298.2±37.8 min TPRC vs. 262.8±37.2 min EPRC , P: 0.001). Early GI complications were lower in EPRC groups, including oral intake intolerance ( 21 vs. 8, P: 0.04), ileus (19 vs. 8, P: 0.04),  intestinal obstruction (3 vs. 0, P: 0.04) and anastomosis leak (8 vs. 1, P: 0.01). Urine leak (14 vs.7 , P: 0.02) and wound related complications (19 vs. 6 , P: 0.02) also favored EPRC group.

The extra-peritoneal technique is beneficial in reducing the post operative morbidity, especially the more prevalent GI complications. This approach is functionally safe and allows preservation of the peritoneal integrity.

Urology journal. 2020 Aug 22 [Epub ahead of print]

Mohammad Soleimani, Ehsan Moradkhani, Navid Masoumi, Jafar Gholivandan

Department of Urology, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences; Tehran/ Iran. ., Urology-Nephrology research center, Shahid Beheshti University of Medical Sciences; Tehran/ Iran. ., Department of Urology, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences; Tehran/ Iran. ., Department of Urology, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences; Tehran/ Iran. .