title: Consequences of peritoneal tears during hand-assisted retroperitoneoscopic nephroureterectomy.
abstract: OBJECTIVE
  To evaluate the possible effects of peritoneal tears during hand-assisted retroperitoneoscopic nephroureterectomy (HARN).
  
  
  METHODS
  Between October 2003 and June 2008, HARN and open bladder cuff excision were performed in 110 patients, 20 of whom had peritoneal tears during the operation. Our policy is not to close the peritoneal defect. We compared the intraoperative and postoperative criteria among the peritoneum-preserved or peritoneum-violated group to evaluate the impacts of peritoneal tears during and after HARN.
  
  
  RESULTS
  All procedures were successful except 2 open conversions in cases without peritoneal tears because of vascular injuries. There was no significant difference in age, American Society of Anesthesiologists class, or body mass index between the 2 groups. Both groups were similar in terms of total operative time (166 vs 137 minutes, P = .06), estimated blood loss (196 vs 268 mL, P = .51), hospital stay (9.1 vs 12.1 days, P = .41), and postoperative analgesia requirements (28.6 vs 28.5 mg morphine equivalent, P = .51). Compared with the peritoneum-preserved group, peritoneal violation during HARN was associated with a heavier specimen weight (308 vs 193 g, P = .01), and 1 patient in the violation group developed small bowel obstruction 3 weeks after the surgery.
  
  
  CONCLUSIONS
  Most peritoneal tears during HARN may be safely managed without peritoneal closure. Bowel obstruction from internal herniation is rare but is too significant to be ignored. To prevent this morbidity, peritoneal tears of a selected size need either repair or enlargement.
authors.affiliation: Department of Urology, National Cheng-Kung University Hospital, Tainan, Taiwan.
authors.forename: Chien-Hui
authors.initials: CH
authors.lastname: Ou
authors.forename: Wen-Horng
authors.initials: WH
authors.lastname: Yang
mesh_terms: D000368:Aged; D058733:Hand-Assisted Laparoscopy; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology*; D009392:Nephrectomy / Q000379:methods*; D010537:Peritoneum / Q000293:injuries*; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D014513:Ureter / Q000601:surgery*