Comparison of Bricker and Wallace Methods of Ureteroileal Anastomosis in Urinary Diversions

Urinary diversion, as described by Bricker in 1950 was for use in adults who required pelvic exenteration for cancer. In this procedure, a 10 to 20 cm length of terminal ileum is isolated from the intestinal tract, and the continuity of the bowel re-established by open end-to-end anastomosis. The appendix is removed. The proximal end of the detached segment of ileum is closed. The ureters are divided from the bladder and anastomosed to the ileal segment, near its blind end through openings in the ileal wall cut to the exact size of each ureter. The distal end of the ileal segment is brought out to the surface of the abdomen in the right lower quadrant through a circular opening cut through skin, fascia, muscle and peritoneum and sutured to the skin to form a slightly protuberant ileal stoma. The various complications encountered with this procedure have prompted the introduction of several modifications. The Wallace method of ureteroileal anastomosis (1966) consists of splaying the distal ureters longitudinally. The medial edges are sutured together with a continuous 5-zero chromic catgut suture. The conjoined ureters are then sutured to the proximal ileal segment with a 4-zero chromic catgut suture at the apex of each ureter to the ileum and a continuous 5-zero chromic suture along the lateral edges. The entire anastomosis is retro- peritonealised. The ileal conduit is brought through the peritoneal cavity to the anterior abdominal wall where a stoma is constructed.