Introduction. The advantages of extraperitoneal laparoscopic access to the prostate are well known - this is an opportunity to avoid the negative effects of pneumoperitoneum and the natural separation of the abdominal cavity from the surgical field. One of the drawbacks is the need to create an artifical cavity. Presence of a cystostomy fistula can significantly complicate the formation of the preperitoneal cavity.
The aim of this research is to analyze our experience in creating extraperitoneoscopic access to the prostate gland in patients with cystostomy fistula.
Materials and methods. From 2015 to 2019, we operated on 153 patients using extraperitoneal access to the prostate gland. Of these, 13 had a cystostomy fistula at the time of the surgery. The formation of the space was carried out according to the original technique without spacemaker balloon. After isolation of the fistulous passage, the latter intersected with suturing on the bladder side with 8-shaped (2–0 vicril).
Results. In all cases, we were able to form a working space sufficient for surgical intervention. In 10 (76,93%) cases, access was created without opening the abdominal cavity, in 3 cases (23,07%) the abdominal cavity was unintentionally opened. There were no complications associated with the creation of a pre-abdominal space.
Discussion. Extraperitoneal access to the prostate reduces the likelihood of damage to the abdominal organs, reduces the angle of inclination of the patient in the Trendelenburg position, does not require the creation of a pneumoperitoneum, with its adverse effect on the cardiovascular system, and also preserves the natural barriers between the surgical area and the abdominal cavity. The presence of a cystostomy in a patient is not an obstacle to this surgical access, the technical feasibility and safety of which was demonstrated in our study.
Conclusion. Thus, extraperitoneal access to the prostate gland in the presence of a cystostomy fistula can be safely created in most cases