Enhanced recovery after laparoscopic or robotic-assisted ureteral reconstruction: identification of modifiable factors in a prospective study.

PURPOSE: To evaluate the bowel function recovery following ureteral reconstruction and identify the associated factors.

METHODS

We conducted a prospective study enrolling 98 patients undergoing transperitoneal laparoscopic or robotic-assisted ureteral reconstruction. The time to resumption of gas evacuation and defecation were used to evaluate the bowel function recovery. Student's t-test, Chi-squared test, Pearson's correlation, and linear regression were performed to identify independent factors. Nomograms were developed to predict early resumption of gas evacuation and defecation.

RESULTS

Factors associated with delayed postoperative flatus passage included old age, lower ureteral strictures, opioids exposure, phloroglucinol use, and late ambulation. Delayed resumption of defecation was associated with female, use of two inhalation anesthetics, lower ureteral strictures, supine position, analgesia pump use, and late ambulation. The low-risk group achieved approximately 10-20% shorter recovery times for both flatus passage and defecation. The areas under the receiver operating characteristic curve for the prediction models for early resumption of gas evacuation and defecation were 0.807 and 0.839, respectively.

CONCLUSION

High-risk patients (elderly females with ureteral strictures distal to the common iliac vessels) may benefit from avoiding combined inhalation anesthesia during surgery, minimizing usage of phloroglucinol and opioids exposure, and early mobilization postoperatively.