Purpose: Antegrade transperitoneal radical cystectomy is the standard surgical treatment for muscle-invasive bladder cancer. Another approach was established in 1999 by kulkarni et al. a retrograde extraperitoneal approach including extraperitonealization of the ileal neobladder. This study compares the results of the two procedures focusing on postoperative recovery of bowel function and postoperative ileus.

Methods: Forty five patients who underwent radical cystectomy and urinary diversion at urology department of faculty of medicine in Alexandria University from January 2015 to December 2017 were analyzed. Twenty two patients underwent antegrade transperitoneal radical cystectomy. Other twenty three were submitted to the retrograde extraperitoneal technique with extraperitonealization of the neobladder or ileal conduit whenever possible. We compared both techniques regarding postoperative recovery of bowel function and postoperative ileus.

Results: The recovery of intestinal movement including Peristalsis and passage of flatus was significantly earlier in the extraperitoneal approach than after the transperitoneal approach. Regarding to regaining of Peristalsis (mean 15.91 vs. 41.59 hrs; p = <0.001), according to flatus passage (mean 43.83 vs. 73.73 hrs; p= 0.001), respectively.

Conclusions: The retrograde extraperitoneal technique with extraperitonealization of the ileal neobladder or ileal conduit yields significant early recovery of bowel function than the antegrade transperitoneal surgical approach.

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Osama Zaytoun MD

Lecturer at Urology Department Alexandria University