Fast-track surgery and technical nuances to reduce complications after radical cystectomy and intestinal urinary diversion with the modified Indiana pouch

Objectives: With the purpose to reduce the complications of radical cystectomy and intestinal urinary reconstruction a perioperative protocol based on fast-track surgery principles and technical modifications of the original surgical technique was applied to patient candidates for etherotopic bladder substitution. Our protocol included pre-, intra-, and postoperative interventions. The technical variations of the modified Indiana pouch technique were focused on intestinal anastomosis to restore bowel continuity, uretero-colonic anastomoses, and capacity of the reservoir. Results and limitations: From 2003 to 2010, 68 consecutive patients participated in the study. Two patients died due to surgical complications (2.9%). Overall, 24 of 68 patients experienced complications (35.3%). Surgery was needed under general anaesthesia for seven patients (10.2%) and under local anaesthesia for four (5.9%). Medical complications were encountered in 13 of 68 patients (19.1%). According to Clavien grading, complications were grade 5 in two patients, grade 4 in two patients, grade 3b in five patients, grade 3a in four patients, grade 2 in nine patients, and grade 1b in two patients. A limitation of our series is that patients were recruited at a single urologic centre and were operated by a single surgeon. Findings need validation. Conclusions: Progress in the perioperative management of major surgery and technical refinements can contribute to reduced complications. In addition, the use of objective reporting tools will facilitate comparison of studies.