Operative note 29 Advanced
Ileal conduit
What it does: urine out through a short piece of bowel.
- 15 cm ileum. At least 15 cm from the caecum.
- Longer mesentery cut at the far end (it must reach the skin). Short cut near end = better supply.
- Bowel divided with a linear stapler. Rejoined ABOVE the conduit: stapled side to side, the open end stapled across.
- Ureters spatulated 2-3 cm.
- Sewn into 1 "plate", 4/0, starting at the heel.
- Plate joined to bowel, 3/0, running up each side. 8Fr feeding tubes up the ureters, through first.
- Flush 50 mL saline in. Leaks? Rescue stitches.
- Bury the join behind peritoneum. Contains leaks. Protects at future surgery.
- Stoma: skin + fat disc at the marked site. Cruciate cut in the rectus sheath. 4 corner stitches, sheath to bowel wall (stops hernia beside the stoma).
- Conduit out. Mature as a spout, skin to bowel.
- Close the gap beside it. Drain near, not on, the join.
- Watch: Big abdomen? Turnbull loop stoma. Know the name.
From the UroRef Operative Quick Guide.