Creation of Urinary Stoma Before Abdominal Wall Transposition of Ileal Conduit Improves Stomal Protrusion, Eversion, and Symmetry

OBJECTIVES To report a technique of stomal creation before abdominal wall transposition of the conduit that reduces asymmetry, retraction, and stenosis of the stoma. The ileal conduit remains the most common form of urinary diversion. Despite extensive experience with the procedure, a significant rate of stomal complications is still observed. METHODS Unlike the traditional approach, after the segment of the distal ileum is selected and excluded from the bowel continuity, the stoma is prepared intracorporeally. The critical elements of this technique include defatting of the distal mesentery, placement of everting sutures immediately adjacent to the bowel mesentery in a diamond configuration, full-thickness locking sutures to fix the eversion, and fascial fixation sutures on abdominal wall transposition. RESULTS The technique of early stomal maturation has been performed in 45 consecutive ileal conduit procedures. To date, early stomal retraction with poor appliance fit has been observed in 1 patient who underwent simultaneous abdominal wall reconstruction, requiring early revision of the stoma. The remaining stomas have demonstrated excellent protrusion with no requirement for revision owing to stenosis or retraction. CONCLUSIONS To date, we have experienced excellent outcomes with the technique, independent of body habitus or mesenteric thickness. The usual tendency of the stoma to be flush at the position of the mesentery is avoided, and symmetric protrusion of the stoma appears to allow a better stomal appliance fit. The effect on long-term complication rates remains to be defined.