Editing Intestinal Segments and Urinary Diversion (section)

=== Stomach Conduit ===
* '''Rarely indicated; may be considered when the use of other intestinal segments in a patient with a decreased amount of intestine would result in serious nutritional problems'''
* '''Advantages (5):'''
*# '''Electrolyte imbalances rarely occur in patients with normal renal function, although a hypochloremic, hypokalemic, metabolic alkalosis has been described'''
*#* '''Less permeable to urinary solutes'''
*#* '''Has a net excretion of chloride and hydrogen ions rather than a net absorption of them, effectively reversing the acidosis of renal insufficiency; may be preferred option in patients with pre-existing metabolic acidosis or renal dysfunction'''
*# '''Not associated with malabsorption; may be preferred option in patients with short bowel syndrome'''
*# '''Not usually in field of radiation, may be preferred option in patients with previous pelvic radiation'''
*# '''Produces less mucus'''
*# '''Acidic pH reduces bacterial colonization'''
* '''Complications specific to stomach conduit'''
** '''Early:'''
*** '''Gastric retention'''
**** '''Caused by atony of the stomach or edema of the anastomosis'''
*** '''Hemorrhage'''
**** '''Most commonly originating from the anastomotic site'''
*** '''Hiccups'''
**** '''Secondary to gastric distention'''
*** '''Pancreatitis'''
**** '''As a consequence of intraoperative injury.'''
*** '''Gastroduodenal and gastroureteral leaks'''
**** '''Have been reported, occasionally resulting in a fatal outcome'''
** '''Late:'''
*** '''Dumping syndrome'''
*** '''Steatorrhea'''
*** '''Small stomach syndrome'''
*** '''Increased intestinal transit time'''
*** '''Bilious vomiting'''
*** '''Afferent loop syndrome'''
*** '''Hypoproteinemia'''
*** '''Hematuria-dysuria syndrome (from the excreted acid)'''
*** '''Severe metabolic alkalosis associated with respiratory distress'''
**** '''The syndrome of severe metabolic alkalosis in patients who have had a gastrocystoplasty is most likely to occur in patients who have elevated gastrin levels'''
*** '''Megaloblastic or iron deficiency anemia'''
*** '''Severe ulcerative complications'''
**** '''Rare'''
**** '''Long-term histamine (H2) or proton-pump inhibition should be considered for these patients.'''