Jejunal loop interposition in patients with ileal conduit failure after pelvic exenteration.

Although the ileal conduit is currently the most widely used method for urinary diversion in patients undergoing pelvic exenteration, reports continue to accumulate indicating the frequency of long-term complications. Four patients with failure of ileal urinary diversion after pelvic exenteration for invasive pelvic malignancy are presented. All four patients had either multiple pelvic surgical procedures and/or pelvic radiation. Interposition of jejunum between the proximal ureters or renal pelvises and skin was performed with satisfactory results in all four. In patients with pelvic exenteration and failure of ileal urinary diversion this technic offers the following advantages over the conventional revision of the ileal conduit: (1) eliminates use of radiated small intestine which is subject to fistula formation and/or obstruction; (2) avoids the settling of the urinary conduit in the devitalized pelvic space with potential adhesions, fistula formation, or obstruction; (3) ensures proximal jejunal loop is away from area of potential tumor recurrence and field or previous or future radiotherapy; (4) eliminates the extensive dissection of the adherent ileal conduit and subsequent risk of avascular necrosis; and (5) bypasses the radiated fibrotic distal ureters.