LAPAROSCOPIC ASSISTED CONTINENT URINARY-DIVERSION IN THE PIG

Purpose: The ideal urinary reservoir would be low pressure, nonrefluxing and simple to construct. Hohenfellner recently described creating an in situ ureterosigmoidostomy with a 5 to 6 cm. detubularized portion of sigmoid colon and rectum (sigmoid-rectum pouch). In an effort to further study the reconstructive applications of laparoscopy, we sought-to laparoscopically create a sigmoid-rectum pouch in an animal model. In addition, we sought to compare a ''dunked'' (right meter) with a hand-sewn end-to-side ureterocolonic anastomosis (left ureter). Materials and Methods: Nine male domestic pigs underwent laparoscopic creation of a continent urinary diversion. Pouch creation and the ureterocolonic anastomoses were done extracorporeally; ureteral stents were not used. Average operative time was 122 minutes. Eight pigs survived the 10 to 12 week study period. Results: Mean pouch capacity was 360 cc and pouch pressure remained <20 cm.H2O. Stones were noted on the bowel staple line in 44% of the animals. Ureterocolonic obstruction occurred in 11% of the right ureters and 33% of the left ureters. Conclusions: A laparoscopically created continent sigmoid-rectum diversion appears to be feasible. A ''dunked'' ureterocolonic anastomosis provides equivalent or better drainage than a traditional hand-sewn ureterocolonic anastomosis. Problems with stone formation on the titanium staple Line need to be resolved.