Laparoscopic extravesical ureteral reimplantation in adults using intracorporeal freehand suturing: report of two cases.
OBJECTIVE
Laparoscopic extravesical neoureterocystostomy is an infrequently described technique in adults. It is a technically demanding procedure, especially when the intracorporeal freehand suturing technique is used. Our aim is to describe two cases where we used the intracorporeal freehand suturing technique successfully for performing laparoscopic extravesical transperitoneal ureteral reimplantation. We describe the preliminary results of these cases.


METHODS
We performed this surgery in two female patients. The first patient had a low ureterovaginal fistula after abdominal hysterectomy. We performed a laparoscopic extravesical neoureterocystostomy by the refluxing technique. The second patient had a lower-third ureteral stricture. We performed a laparoscopic extravesical neoureterocystostomy with detrusorrhaphy and supported it with a psoas hitch.


RESULTS
The average surgical time was 235 minutes. The average blood loss was 50 mL. The average stay was 48 hours, and the average time to starting oral intake was 12 hours. The average requirement for postoperative analgesia was one injection of diclofenac sodium, followed by oral ibuprofen. Follow-up urography showed good clearance of the kidney and ureter. The second patient, in whom the detrusorrhaphy was performed, did not show any reflux on the postoperative cystogram.


CONCLUSIONS
Laparoscopic extravesical neoureterocystostomy using intracorporeal freehand suturing technique, combining detrusorrhaphy and psoas hitch, is a feasible procedure in adults for various indications. The detrusorrhaphy was effective in preventing reflux, but the long-term results need to be evaluated.
Kamat
Nagesh
N
Kamats Kidney Hospital, Kothi, Baroda, India. kamatnn@hotmail.com
Khandelwal
Pankaj
P
D000328:Adult; D003559:Cystostomy / Q000379:methods; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D007813:Laparotomy / Q000379:methods*; D012092:Replantation / Q000379:methods*; D013536:Suture Techniques; D014513:Ureter / Q000293:injuries / Q000601:surgery*; D014517:Ureteral Obstruction / Q000150:complications; D014548:Urinary Fistula / Q000150:complications; D014624:Vaginal Fistula / Q000150:complications