Laparoscopic Boari Flap for Inadvertent Ureteral Injury During Die Resection

Abstract

Video Objective To demonstrate minimally invasive strategies for inadvertent intraoperative ureteral injury. This case report shows how we managed an extensive ureteral injury while dissecting DIE. Setting Urban general hospital in Japan. Interventions This patient suffered from DIE and extensive and severe fibrosis. As a result of the severe and extensive fibrosis, the surgeon performing the DIE resection misrecognized the ureter for the deformed sacrouterine ligament and this structure was coagulated and resected. The author of this report was called to take over the repair and reconstruction of the ureter. The laparoscopic Boari flap with psoas hitch technique was performed to compensate for the large ureteral defect. In the Boari flap technique, the ureter is mobilized cranially and the bladder is also dissected and mobilized. Then a flap is cut from the wall of the bladder and this flap is suture fixed to the psoas fascia and enveloped to make a tunnel for the cut end of the ureter. Conclusion The patient was able to ambulate and take and normal diet the next day. No stenosis or leaks occurred and no blood transfusions were required. Although the technique is demanding, we are able to avoid open surgery, making this strategy a good, patient friendly option when a repair scenario is needed.