Videosurgery
3-D laparoscopic ureteric reimplantation with Boari Flap for long segment ureteric stricture secondary to genito-urinary tuberculosis: Our experience
Pankaj Gupta, Sandeep Kumar, Siddharth Yadav, Y. M. Prasanth, Vijay Tyagi, Vishnu Prasad, Kumar Saurav
Department of Urology and Renal Transplant, VMMC and Safdarjang Hospital, New Delhi, India
Citation: Gupta P, Kumar A, Kumar S, et al. 3-D laparoscopic ureteric reimplantation with Boari Flap for long segment ureteric stricture secondary to genito-urinary tuberculosis: Our experience. www.ceju.online/journal/2019/laparoscopic-boari-flap-ureteric-stricture-1849.php
Key Words: laparoscopic boari flap • ureteric stricture

Introduction and objectives. 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. Weprospectively evaluatedour experience of 3-D laparoscopic ureteric reimplantation with boari flap for long ureteric strictures secondary to GUTB.


Materials and methods. In this prospective study, all consecutive patients with long segment ureteric stricture with GUTB, requiringboari 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.

Article history
Submitted: 3 January, 2019
Accepted: 12 February, 2019
Published online: 14 February, 2019
doi: 10.5173/ceju.2019.1849
Corresponding author
Pankaj Gupta
email: panki.doc@gmail.com
Conflicts of interest:  The authors declare no conflicts of interest.
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