Сравнительный анализ эффективности и безопасности открытой и лапароскопической техники пластики дистального мочеточника по Боари

Abstract

Introduction Distal ureter strictures are complications of surgical interventions for obstetric, gynecological, urological, vascular and oncological diseases. Reconstructive plastic correction of these strictures is a complex urological procedure. The choice of a technique is associated with the localization and extent of the stricture. Boari flap ureteroneocystostomy is one of the main operations to choose from. Its implementation in open and laparoscopic versions in recent history required special analysis. Objective to analyze the experience of ureteral reimplantation according to the Boari technique with a detailed description of its open and laparoscopic approaches. Materials and methods In 2010-2019, 30 patients underwent surgery using the Boari technique. 17 patients underwent open surgery (group 1) and 13 patients underwent surgery using laparoscopic techniques (group 2). A comparative analysis of the two groups was carried out considering clinical and intraoperative data. Complications were studied, as well as immediate and long-term results with a follow-up period of 6-120 months. Results Patients of the two groups showed similar clinical characteristics. Patients had an equal extent of lesion in the groups (p>0.05). However, the lesions were located more proximally from the bladder in group 1, which required the use of longer flaps (p=0.024). Blood loss volume was identical, and the duration of laparoscopic operations was significantly shorter (p=0.019). Postoperative complications occurred in 26.7% of cases in the next 3 months, which required a temporary percutaneous puncture nephrostomy (IIIa degree according to Clavien-Dindo) in 2 cases and conservative therapy (II degree according to Clavien-Dindo) in 6 cases. Clinical vesicoureteral reflux was determined in only one case during a one-year follow-up period. Conclusion Open and laparoscopic Boari techniques have an equally high ureteral recovery efficiency without the need for a re-operation in all cases. Refluxing flap ureteral anastomosis is extremely rarely accompanied by a clinic of vesicoureteral reflux. The ureter can be restored using a laparoscopic Boari technique in all cases.