Laparoscopic assisted ileal ureter: technique, outcomes and comparison to the open procedure.
OBJECTIVE
Ureteral replacement with interposition of a bowel segment has traditionally required a large incision with substantial associated morbidity and prolonged time to convalescence. During the last 7 years a technique for laparoscopic assisted ileal interposition has evolved that mimics our open approach. We present a comparative analysis of functional and perioperative outcomes between patients undergoing laparoscopic or open ileal ureter replacement at our institution.


METHODS
A search of all procedures from 1980 to the present revealed 7 patients undergoing laparoscopic and 7 undergoing open ileal interposition. Functional and perioperative data from these patients are compared, and a detailed description of technique for the laparoscopic procedure is presented.


RESULTS
Narcotic analgesic use in morphine equivalents (median 38.9 vs 322.2 mg, p = 0.035) and time to convalescence (median 4 vs 5.5 weeks, p = 0.03) were significantly less in the laparoscopic group. A trend toward shorter hospital stay (median 5 vs 8 days, p = 0.101) was also noted in patients in the laparoscopic group. There was no evidence of anastomotic stricture for patients in either group at last followup.


CONCLUSIONS
Despite the small number of subjects involved a significant advantage was noted for postoperative recovery after laparoscopic compared to open ileal interposition. A detailed understanding of this complicated procedure can help prevent inherent pitfalls.
Stein
Robert J
RJ
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA. steinr@ccf.org
Turna
Burak
B
Patel
Neil S
NS
Weight
Christopher J
CJ
Nguyen
Mike M
MM
Shah
Gaurang
G
Aron
Monish
M
Fergany
Amr F
AF
Gill
Inderbir S
IS
Desai
Mihir M
MM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007082:Ileum / Q000637:transplantation*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D016896:Treatment Outcome; D014515:Ureteral Diseases / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*; D055815:Young Adult