Editing Orthotopic Urinary Diversion (section)

== Indiana Pouch ==

* '''Non-orthotopic, continent urinary diversion'''
* '''Uses a buttressed ileocecal valve as a dependable continence mechanism that can withstand the trauma of intermittent catheterization'''
* '''Involves isolating a segment of terminal ileum ≈10 cm in length along with the entire right colon to the junction of the right and middle colic artery blood supplies.'''
* After bowel continuity is reestablished, appendectomy is performed. The entire right colon is opened along its antimesenteric border, and ureteral-taenial implants are fashioned. The ileocecal junction is buttressed according to various reported techniques. With nonabsorbable sutures, interrupted Lembert sutures are taken over a distance of 3-4 cm in two rows for the double imbrication of the ileocecal valve. The second row of sutures should attempt to bring the opposite mesenteric edges of ileum together, usually over a 12- to 14-Fr catheter. These two rows of sutures should be placed approximately 8 mm from one another, and the initial suture in each row may be taken in a purse-string fashion around the cecal margin as well.
* Early complications include pouch leak, transient small bowel obstruction
* Late complications include incontinence, stomal stenosis, parastomal hernia, stones, small bowel obstruction