Department of Urology,, Rabin Medical Center, 49372, Petach Tikva, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
BMC Urol. 2022 Sep 3;22(1):138. doi: 10.1186/s12894-022-01095-4.
Fascial dehiscence after radical cystectomy may have serious clinical implications. To optimize its management, we sought to describe accompanying intraabdominal findings of post-cystectomy dehiscence repair and determine whether a thorough intraabdominal exploration during its operation is mandatory.
We retrospectively reviewed a multi-institutional cohort of patients who underwent open radical cystectomy between 2005 and 2020. Patients who underwent exploratory surgery due to fascial dehiscence within 30 days post-cystectomy were included in the analysis. Data collected included demographic characteristics, the clinical presentation of dehiscence, associated laboratory findings, imaging results, surgical parameters, operative findings, and clinical implications. Potential predictors of accompanying intraabdominal complications were investigated.
Of 1301 consecutive patients that underwent cystectomy, 27 (2%) had dehiscence repair during a median of 7 days post-surgery. Seven patients (26%) had accompanying intraabdominal pathologies, including urine leaks, a fecal leak, and an internal hernia in 5 (19%), 1 (4%), and 1 (4%) patients, respectively. Accompanying intraabdominal findings were associated with longer hospital stay [20 (IQR 17, 23) vs. 41 (IQR 29, 47) days, P = 0.03] and later dehiscence identification (postoperative day 7 [IQR 5, 9] vs. 10 [IQR 6, 15], P = 0.03). However, the rate of post-exploration complications was similar in both groups. A history of ischemic heart disease was the only predictor for accompanying intraabdominal pathologies (67% vs. 24%; P = 0.02).
A substantial proportion of patients undergoing post-cystectomy fascial dehiscence repair may have unrecognized accompanying surgical complications without prior clinical suspicion. While cardiovascular disease is a risk factor for accompanying findings, meticulous abdominal inspection is imperative in all patients during dehiscence repair. Identification and repair during the surgical intervention may prevent further adverse, possibly life-threatening consequences with minimal risk for iatrogenic injury.
根治性膀胱切除术后筋膜裂开可能具有严重的临床意义。为了优化其治疗，我们试图描述膀胱切除术后筋膜裂开修补术时的伴随腹腔内发现，并确定在手术过程中是否需要彻底进行腹腔探查。
我们回顾性分析了 2005 年至 2020 年间接受开放根治性膀胱切除术的多机构队列患者。在膀胱切除术后 30 天内因筋膜裂开而行探查性手术的患者被纳入分析。收集的数据包括人口统计学特征、裂开的临床表现、相关实验室检查结果、影像学结果、手术参数、手术发现和临床意义。研究了伴随腹腔内并发症的潜在预测因素。
在 1301 例连续接受膀胱切除术的患者中，有 27 例（2%）在手术后中位数为 7 天内行裂开修补术。7 例（26%）患者有伴随的腹腔内病变，包括尿漏、粪漏和内疝，分别为 5 例（19%）、1 例（4%）和 1 例（4%）患者。伴随的腹腔内发现与更长的住院时间相关[20（IQR 17，23）天与 41（IQR 29，47）天，P=0.03]和更晚的裂开识别[术后第 7 天（IQR 5，9）与第 10 天（IQR 6，15），P=0.03]。然而，两组的术后探查并发症发生率相似。缺血性心脏病史是伴随腹腔内病变的唯一预测因素（67%比 24%；P=0.02）。
在接受膀胱切除术后筋膜裂开修补术的患者中，相当一部分患者可能在没有临床怀疑的情况下存在未被识别的伴随手术并发症。虽然心血管疾病是伴随发现的危险因素，但在所有患者中，在裂开修补术期间都需要进行仔细的腹部检查。在手术干预过程中识别和修复可能会防止进一步的不良、可能危及生命的后果，且对医源性损伤的风险最小。
