LAPAROSCOPIC APPROACH FOR URETEROLYSES AFTER A URETERONEOCYSTOSTOMY DUE TO AN IATROGENIC INJURY

V8-07
J. B. Mendes1,M. T. Tanaka1, E. F. Pacagnan1, M .R. .S. S. B. Mendes2, A. S. Tanaka1, R. A. P. Cruzatti3

1Master Clínica, Cascavel, Brazil, 2Unioeste, Cascavel, Brazil, 3Cíinica Plena, Toledo, Brazil
Introduction: Considering the difficulties and challenges faced by the surgeon when repairing iatrogenic organ injuries, laparoscopy seems, for most of us, as an unsuitable approach. In addition, the surgeon’s technical skill demand and the number of such laparoscopic repair reports in the literature deny laparoscopy as a first treatment option.

Method: A 57-year-old female patient underwent a laparoscopic approach 7 months after a laparoscopic ureteroneocystostomy due to a ureterohydronephrosis secondary to a right ureteral injury during a laparoscopic rectosigmoidectomy.  After 7 months following this inicially successful ureteroneocystostomy, the pacient started to complain about a flank pain and a recurrence of the prior ureterohydronephrosis was detected on an intravenous pyelogram (IVP). She underwent a new transperitoneally laparoscopic surgery, with three port-sites and at a Trendelenburg position. The obstruction cause was detected during surgery as being a fibrotic constricting band, 4 to 5 centimeters above the uretero-vesical junction. Immediatelly after releasing this band, a good ureteral drainage restoration was accomplished. In order do avoid adhesion recurrences, an epiploon ureteroplasty was performed. No stent was left behind in both ureteral surgeries.

Result: The hospital stay was 3 days and the post-operative pain complaint was very light for both ureteral procedures. Follow up, included an IVP and ultrasonography studies, which results at 16 months after the ureterolysis showed a steady right hydronephrosis recovery.

Conclusion: Despite the expected difficulties generally encountered during re-operations, as well as no technical standardization for some laparoscopic procedures, this video show the feasibility of such kind of complex procedures.