Category: Laparoscopy: Upper Tract - Benign
VS14-8 - 3-D laparoscopic ureteric reimplantation with Boari Flap for long segment ureteric stricture secondary to Genito-Urinary Tuberculosis(GUTB) :Our experience
Introduction & Objective :
In genitourinary tuberculosis(GUTB),long segment ureteric stricture (8-12 cm)is a common presentation ,requiring Boari flap reconstruction . Laparoscopic reconstructive surgery in GUTB is technically challenging.We prospectively evaluated our experience of 3-D laparoscopic ureteric reimplantation with boari flap for long ureteric strictures secondary to GUTB.
Methods :
In this prospective study, all consecutive patients with long segment ureteric stricture with GUTB ,requiring boari flap reconstruction were included.All patients received preoperative Anti-tubercular therapy for 6 weeks before surgery and continued ATT postoperatively for full 1 year .The various clinical data were recorded and analyzed. We are presenting video of one such case.
Results : A total of 9 patients were included in the study. The mean age was 31.9 years .The male to female and right to left distribution were 5/4 and 6/3 respectively .The mean ureteral defect was 9.3 cm.All patients were on percutaneous nephrostomy preoperatively.The mean operating time and mean estimated blood loss were 151.7 min and 91.3 ml respectively .There was no open conversion and intraoperative complications.The mean catheterization time ,mean hospital stay and mean convalescence were 10.3 days ,3.9 days and 1.7 weeks respectively.At mean follow up of 29.1 months ,postoperative complications were mainly clavien 1 and 2 in only 2 patients .All the patients showed non obstructed drainage at 1 year on DTPA scan and CT urography .The mean serum creatinine was preserved on 1.1 mg/dl at 1 year
Conclusions :
3-D laparoscopic ureteric reimplantation with Boari Flap for long segment ureteric stricture secondary to GUTB is feasible,safe with excellent long term efficacy.However,it is a technically challenging procedure and should be done by surgeons of significant laparoscopic expertise.
Anup Kumar
– Professor and Head, Department of Urology and Renal transplant , VMMC and Safdarjang Hospital ,New Delhi, Delhi, Delhi, India- NK
Niraj Kumar
– Assistant Professor, Department of Urology and Renal transplant , VMMC and Safdarjang Hospital ,New Delhi, Delhi, Delhi, India - PV
Pawan Vasudeva
– Professor, Department of Urology and Renal transplant , VMMC and Safdarjang Hospital ,New Delhi, Delhi, Delhi, India - SY
Siddharth Yadav
– Assistant Professor, Department of Urology and Renal transplant , VMMC and Safdarjang Hospital ,New Delhi, Delhi, Delhi, India - SK
Sandeep Kumar
– Assistant Professor, Department of Urology and Renal Transplant ,VMMC and Safdarjang Hospital,New Delhi,India, Delhi, Delhi, India - PG
Pankaj Gupta
– Senior resident, Department of Urology and Renal Transplant, VMMC and Safdarjang Hospital, New Delhi, India, Delhi, Delhi, India - SK
Saurav Kumar
– Senior Resident, Department of Urology and Renal Transplant, VMMC and Safdarjang Hospital, New Delhi, India, Delhi, Delhi, India - VP
Vishnu Prasad
– Senior Resident, Department of Urology and Renal Transplant, VMMC and Safdarjang Hospital, New Delhi, India, Delhi, Delhi, India - YP
Y m Prashant
– Senior Resident, Department of Urology and Renal Transplant, VMMC and Safdarjang Hospital, New Delhi, India, Delhi, Delhi, India - VT
Vijay Tyagi
– senior Resident, Department of Urology and Renal Transplant, VMMC and Safdarjang Hospital, New Delhi, India, Delhi, Delhi, India