EARLY POSTOPERATIVE COMPLICATIONS IN RADICAL CYSTECTOMY WITH BRICKER ILEAL CONDUIT UNDER THE ENHANCED RECOVERY AFTER SURGERY (ERAS) PROTOCOL

Radical cystectomy with pelvic lymph node dissection remains the standard surgical management for muscle-invasive and recurrent high-risk non-muscle-invasive bladder cancer. Despite improvements in surgical technique and anesthetic management, this procedure remains one of the most traumatic in oncourology: early (up to 30 days) postoperative complication rates reach 60–70% according to literature data, while the incidence of grade III and higher complications according to the Clavien-Dindo classification ranges from 15% to 25%. Urinary diversion via the Bricker method (ileal conduit) is primarily performed in elderly and senile patients with significant comorbidities, reduced physiological reserve, and a high Charlson Comorbidity Index. This makes this cohort particularly susceptible to postoperative complications such as paralytic ileus, anastomotic leakage (entero-enteric and ureteroileal), wound infection, lymphorrhea, thromboembolic events, and metabolic disorders. The Enhanced Recovery After Surgery (ERAS) protocol, which integrates a set of preoperative, intraoperative, and postoperative interventions (avoidance of routine mechanical bowel preparation, shortened preoperative fasting, preoperative carbohydrate loading, multimodal analgesia with opioid minimization, PONV prophylaxis, early mobilization, and early enteral nutrition), has demonstrated efficacy in colorectal surgery; however, its outcomes in radical cystectomy remain controversial, and reports on an isolated cohort of patients with an ileal conduit are limited.