Comparison of Post-Radical Cystectomy Ileus Rates Using GIA-80 versus GIA-60 Intestinal Stapler Device.

OBJECTIVE: To assess the impact on recovery of bowel function using an 80 mm versus 60 mm gastrointestinal anastomosis (GIA) stapler following radical cystectomy and urinary diversion (RC/UD) for bladder cancer.

METHODS: We identified 696 patients using a prospectively maintained RC/UD database from January 2006-November 2010. Two nonrandomized consecutive cohorts were compared. Patients between January 2006-December 2007 (n=180) were treated using a 60mm GIA stapler, and 331 patients between January 2008-December 2010 were subject to an 80 mm GIA stapler. All patients were treated on the same standardized postoperative recovery pathway. After accounting for baseline patient and perioperative characteristics, using a multivariable logistic regression model we directly compared rates of postoperative ileus using a standardized definition.

RESULTS: Of 511 evaluable patients, ileus was observed in 32% (57/180) for 60mm GIA versus 33% (110/331) for the 80mm GIA. Preoperative renal function, age, gender, BMI, and type of diversion were comparable between cohorts. On multivariate analysis, stapler size was not significantly associated with the development of ileus (GIA-60 vs. GIA-80: OR 1.11; 95% CI 0.75, 1.66; p=0.6). Positive fluid balance was associated with an increased risk (p=0.019) and female sex a decreased risk (p=0.008) of developing ileus compared to patients with negative fluid balance.

CONCLUSIONS: The size of the intestinal bowel anastomosis (GIA 80 mm vs 60 mm) does not independently impact the time to bowel recovery following RC/UD.