Video-Assisted Double-Barreled Wet Colostomy: A New Minimally Invasive Simultaneous Diversion to Patients After Pelvic Radiation Therapy Marcos Tobias-Machado, MD, PhD, Maria C. Bicudo, MD, Paulo R. Appolonio, MD, Fernando Korkes, MD, Eduardo S. Starling, MD, Antonio C.L. Pompeu, MD, PhD, and Eric R. Wroclawski, MD, PhD Abstract Introduction: A wet colostomy can be done when the simultaneous diversion of fecal and urine streams are necessary. Laparoscopic access is gaining space in urinary diversion procedures. The aim of the present study was to present the technique and results of the first case reported of a video-assisted double-barreled wet colostomy. Patient and Methods: In this article, we report a case of a 50-year-old woman with actinic complex urinary and fecal fistula, treated through a retroperitoneoscopic double-barreled wet colostomy. Only the left kidney had function, so she was treated by video endoscopic retroperitoneal dissection of the left ureter, preplanned transverse 5-cm incision for exteriorization of left colon and ureter, extracorporeal section of the left colon with a linear stapler, extracorporeal antireflux ureterocolonic anastomosis, and maturation of the stoma 10 cm proximal to the end of the proximal colonic loop. Results: Operative time was 135 minutes. No transfusion was required nor had intraoperative complications occurred. Oral intake was initiated in postoperative day 2, and the patient was discharged postoperative day 6 without complications. Normal activities were recovered after 21 days. In a 3-month follow-up, there were no infectious complications, and good urinary drainage was observed. She was satisfied and adapted to the stoma. Conclusions: Video-assisted double-barreled wet colostomy is a feasible procedure. The same goals of the open procedure were achieved, offering the advantages of the laparoscopic approach. Introduction M any patients who undergo large pelvic resections, whether to manage tumors or recurrence after radia- tion therapy, or yet to treat actinic complications, may need the simultaneous diversion of urinary and fecal streams. Usually, diversion through two stomas is performed. 1–6 Si- multaneous fecal and urinary diversion through wet colos- tomy have initially presented with prohibitive complications due to ascendant urinary tract infections, anastomotic steno- sis, electrolytic imbalance, and urinary and fecal leakage. 7 In 1952, Teicher et al. 8 reported the first successful wet co- lostomy performed after pelvic exenteration, through a ur- eterosigmoid diversion. However, this patient developed pyelonephritis and was treated with a new diversion, isolat- ing the urinary tract to a sigmoid loop. In 1989, Carter et al. 7 described the double-barreled wet colostomy, which consisted of a colonic loop diversion, anas- tomosing the ureters 10 cm distally to the stoma. The rationale was to create a distal reservatory with free urine flow and without feces. It is a simple, safe procedure that keeps urine apart from the fecal stream, reducing the risk of infection. Moreover, colonic segments, different from the small bowel, are, in general, protected from radiation effects. Since Sanchez de Badajos et al. 9 have described an experimental model for performing endoscopic ureteroileostomy with extracorporeal urinary diversion, many researchers have performed laparo- scopic and robotic-assisted urinary diversion, whether with intra- or extracorporeal anastomosis. 10,11 Although technically challenging, ongoing technical refinements of reconstructive laparoscopy are making these procedures more widely ap- plicable. 12 We treated a patient with a complex urinary and Section of Urologic Oncology, Department of Urology, ABC Medical School and Brazilian Institute of Cancer Control (IBCC), Sa ˜ o Paulo, Brazil. JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES Volume 19, Number 6, 2009 ª Mary Ann Liebert, Inc. DOI: 10.1089=lap.2009.0029 803