title: Technical modifications to laparoscopic Boari flap.
abstract: BACKGROUND
  To describe technical modifications to the laparoscopic Boari flap ureteroneocystostomy procedure.
  
  
  METHODS
  Removal of ureteral stents with conversion to percutaneous nephrostomy drainage before surgery allowed for optimization of tissue quality and visualization during operative repair. Adherence to specific dimensional ratios during flap excision consistently provided for adequate tissue for successful Boari flap construction. A mucosal modification to the Boari flap allowed for an increase in the circumference of the anastomosis and provided an additional means to fortify the suture line and promote healing. Raised mucosal flaps on the Boari flap facilitated construction of a nonrefluxing anastomosis. Finally, a 2-mm needlescopic port placed at the level of the anastomosis facilitated simplified intracorporeal double-J ureteral placement.
  
  
  CONCLUSIONS
  Laparoscopic Boari flap ureteroneocystostomy is an effective treatment of distal ureteral stricture disease. The technical modifications describe in this report aim to contribute to increased success rates in patients who undergo this procedure.
authors.affiliation: Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Matthew N
authors.initials: MN
authors.lastname: Simmons
authors.forename: Inderbir S
authors.initials: IS
authors.lastname: Gill
authors.forename: Amr F
authors.initials: AF
authors.lastname: Fergany
authors.forename: Jihad H
authors.initials: JH
authors.lastname: Kaouk
authors.forename: Mihir M
authors.initials: MM
authors.lastname: Desai
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D003559:Cystostomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D013524:Surgical Flaps; D014517:Ureteral Obstruction / Q000601:surgery*; D014519:Ureterostomy / Q000379:methods*