Laparoscopic Ureterolysis and Omental Wrapping

Objectives

To describe our laparoscopic technique of ureterolysis and omental wrapping using the LigaSure device for the treatment of idiopathic retroperitoneal fibrosis.

Methods

Four bilateral laparoscopic ureterolyses (LUs) and two unilateral LUs were performed in 6 male patients (mean age 47 years). Of the 6 patients, 4 underwent LU without having undergone medical therapy before surgery and 2 underwent LU after medical therapy failure. All had had ureteral stents placed before surgery. The ureters were completely freed from the fibrotic tissue using an Overholt laparoscopic forceps and 10-mm LigaSure atlas. An omental wrap was passed behind the colonic flexure, placed around the ureter, and fixed to the psoas muscle.

Results

The mean operating time was 80 minutes (range 75 and 85) for the unilateral LUs and 200 minutes (range 180-225) for the bilateral procedures. The mean blood loss was 75 mL (range 50 and 100) during LUs and 150 mL (range 80-220) during bilateral LUs. The mean hospital stay was 3.33 days (range 2-5). All indwelling ureteral stents were removed at 4 weeks postoperatively. At a mean follow-up of 37.5 months (range 23-59), all patients were free of symptom and all renal units were unobstructed.

Conclusions

In our experience of LUs and omental wrapping, the reproduction of each step of open surgery seems to offer excellent midterm outcomes. The use of the LigaSure simplified the laparoscopic procedure and made it feasible and safe. We believe that the minimally invasive nature and high effectiveness of LU suggest consideration of this procedure as first-line treatment of idiopathic retroperitoneal fibrosis.