Effectiveness of Guardix-SG in Preventing Postoperative Bowel Complications After Radical Cystectomy: A Single-Arm Prospective Observational Study
10.22465/juo.255000660033
- Author:
Jiwoong YU
1
;
Wan SONG
;
Minyong KANG
;
Hyun Hwan SUNG
;
Hwang Gyun JEON
;
Seong Il SEO
;
Seong Soo JEON
;
Byong Chang JEONG
Author Information
1. Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Publication Type:Original Article
- From:
Journal of Urologic Oncology
2025;23(3):253-259
- CountryRepublic of Korea
- Language:English
-
Abstract:
Purpose:This study aimed to evaluate the effectiveness of intraoperative Guardix-SG application in reducing postoperative ileus (POI) and preventing adhesive small bowel obstruction (SBO) following radical cystectomy (RC) for bladder cancer.
Materials and Methods:A single-arm, prospective observational study was conducted from April 2022 to February 2025. Sixty-seven patients undergoing RC with pelvic lymph node dissection received intraoperative Guardix-SG application after urinary reconstruction. Patients with prior abdominal surgery or pelvic radiotherapy were excluded. POI was defined as (1) the absence of flatus or stool by postoperative day (POD) 6 (definition 1) or (2) intolerance to oral intake by POD 5 requiring nasogastric decompression or intravenous support (definition 2). Adhesive SBO was defined as radiologic or clinical bowel obstruction without a mechanical cause. Outcomes were monitored for 3 months. Predictors of POI (definition 2) were identified using multivariable logistic regression.
Results:The median age was 69.0 (interquartile range, 62.5–75.0) years, and 88.1% of participants were male. Robot-assisted surgery was performed in 62.7% of cases, and ileal conduit diversion was most common (64.2%). The incidence of POI was 3.0% (2 of 67) by definition 1 and 19.4% (13/67) by definition 2. Nasogastric tube placement was required in 6.0% (4 of 67). No cases of adhesive SBO or gastrointestinal reoperation were observed. Multivariable analysis identified lower body mass index as an independent predictor of POI (odds ratio, 0.74; 95% confidence interval, 0.57–0.96; p=0.023). No significant associations were found with surgical approach, diversion type, or operative time. Compared with previous studies reporting SBO rates of 3%–5% and POI rates of 14%–27%, the observed complication rates were lower or comparable.
Conclusion:Intraoperative Guardix-SG application resulted in favorable bowel outcomes after radical cystectomy, with no observed SBO and a reduced incidence of POI.
