Complications Of Obstruction Research Articles

Defunctioning loop ileostomy for rectal anastomoses: predictors of stoma outlet obstruction.

Creation of defunctioning loop ileostomy is a standard procedure in laparoscopic lower rectal surgery. Stoma-related obstruction sometimes occurs, but its cause has not been fully analyzed. This study aims to assess stoma obstructive complications and clarify the risk factors of stoma-related obstructions. Two hundred and thirty consecutive patients who underwent laparoscopic rectal cancer surgery with defunctioning loop ileostomy between April 2007 and December 2017 were recruited, numbering 230. We statistically examined the frequency and risk factor of stoma outlet obstruction. Postoperative stoma-related complications developed in 41 patients (17.8%) overall, and there was no 30-day mortality. Stoma outlet obstructions occurred in 16 patients (7.0%) during postoperative course. Thick subcutaneous fat at the stoma-marking site (vertical distance ≥ 20mm) and body mass index (≥ 22.2) were significantly associated with the risk of stoma outlet obstruction in univariate analysis. Thick subcutaneous fat was a significant predictive factor of stoma outlet obstruction according to multivariate analysis (odds ratio 3.80). This report investigates significant predictors of stoma outlet obstruction in laparoscopic rectal cancer surgery for the first time. In laparoscopic procedure, stoma outlet obstruction should be particularly considered in obese patients who have especially thick subcutaneous fat of the abdominal wall.

Residual neuromuscular block in vulnerable patients: Obesity, obstructive sleep apnea and postoperative pulmonary complications

Residual neuromuscular block in vulnerable patients: Obesity, obstructive sleep apnea and postoperative pulmonary complications

Prevention of Postoperative Adhesion Formation Using Noninvasive Technology [38F

INTRODUCTION: Postoperative adhesions occur following laparoscopic and open procedures, cause pain, infertility, bowel obstruction and other complications. Surgically-induced tissue injury causes inflammation and hypoxia resulting in alterations in cytochrome c oxidase (COX) activity, mitochondrial membrane potential (ΔΨm) hyperpolarization and reactive oxygen species (ROS) production. ROS initiate a cascade causing the irreversible transformation of fibroblasts to adhesion phenotype in injured peritoneum. Infrared light (IRL) can modulate COX activity through the following mechanism: IRL → COX activity↓ → ΔΨm↓ → ROS↓ → TGF-β1↓→ prevention of adhesion phenotype, making adhesion-free surgery possible. METHODS: Mitochondrial respiration, ROS, and ΔΨm were analyzed. Adhesion markers were measured by ELISA. Electrocautery and cytobrush were used to traumatize peritoneal tissue in Sprague-Dawley rats. Tissues, evaluated and harvested on day 7, were cryosectioned, hematoxylin/eosin stained, and immunofluorescence analyzed with confocal microscopy. IRL was generated by light emitting diodes. RESULTS: COX activity increases in injured peritoneum. IRL significantly decreased COX activity, whole cell respiration, ΔΨm, and ROS production. Hypoxia, ischemia/reperfusion and hyperoxia increased ROS, ΔΨmand TGFβ1 in macrophages, neutrophils and fibroblasts and transformed fibroblasts to adhesion phenotype. IRL robustly decreased ROS, ΔΨmand TGF-β1 and abrogated conversion to adhesion phenotype in vitro. Rats treated with IRL following adhesion surgery had lower numbers and severity of adhesions on gross examination, less fibrosis on histology and less adhesion marker expression on immunofluorescence compared to untreated controls. CONCLUSION: IRL may be used to non-invasively modulate COX activity, decrease ROS and decrease the conversion of fibroblasts to adhesion phenotype limiting postoperative adhesions.

Sa1804 – Incidence of Obstructive Complications After Intraabdominal Surgeries in Patients with Crohn's Disease Receiving Care At 12 Veterans Affairs Medical Centers

Sa1804 – Incidence of Obstructive Complications After Intraabdominal Surgeries in Patients with Crohn's Disease Receiving Care At 12 Veterans Affairs Medical Centers

The role of MDCT in the diagnosis of small bowel obstruction secondary to multiple adhesion bands: A case report

Adhesion band is a major cause of small bowel obstruction. Traditionally, the obtained results of computed tomography (CT) scan were indicative of adhesion band as an etiology for small bowel obstruction. However, adhesion is easily diagnosed today due to technological advances in radiology and high-quality multidetector CT. It is important to avoid the possible complications of bowel obstruction in the early and appropriate surgical intervention. This article is a report of a 45-year-old woman with abdominal pain and history of previous abdominal surgery. A contrast-enhanced CT scan showed multiple adhesion bands ensued the abrupt narrowing of bowel diameter and closed small-bowel loops obstruction. Furthermore, multiple bands were clearly observed and adhesiolysis was performed in the surgery.

Ureteral reconstruction with decellularized small intestinal submucosa matrix for ureteral stricture: A preliminary report of two cases

ObjectiveTo determine the feasibility of decellularized small intestinal submucosa (SIS) matrix in repairing ureteral strictures. MethodsTwo patients with ureteral stenoses underwent ureteral reconstruction with SIS matrix at the Zhejiang Provincial Corps Hospital of Chinese People's Armed Forces between June 2014 and June 2016. The ureteral stenoses were repaired with a semi-tubular SIS matrix and the postoperative recoveries were observed. ResultsBoth operations were successfully completed. The average operative time was 90 min and the average length of hospital stay was 15 days. No fevers, incision infections, intestinal obstruction, graft rejection, or other serious complications were noted. After 2 months, ureteroscopic examinations showed that the surfaces of the original patches were covered by mucosa and there were no apparent stenoses in the lumens. The ureteral stents were replaced every 2 months postoperatively and removed 12 months postoperatively. No infections or urinary leakage occurred after removal of the stents. Intravenous urography was performed 6 and 12 months postoperatively. The results showed that the ureters were not obstructed and there was no apparent stenosis at the anastomosis sites. The average follow-up time was >12 months. Long-term follow-up is still ongoing, and computed tomography examinations of the urinary tract have been conducted in the outpatient department of our hospital 1, 3, and 6 months after removal of the double-J stents, suggesting the absence of hydronephrosis. The serum creatinine levels remained stable during the follow-up. ConclusionSIS matrix reconstruction is a feasible method to repair ureters stenosis.

Comparison of the Transarterial and Transthoracic Approaches in Nontransfemoral Transcatheter Aortic Valve Implantation

Transfemoral approach stands as the reference access-route for transcatheter aortic valve implantation (TAVI). Nonetheless, alternatives approaches are still needed in a significant proportion of patients. This study aimed at comparing outcomes between transthoracic-approach (transapical or transaortic) and transarterial-approach (transcarotid or subclavian) TAVI. Data from 191 consecutive patients who underwent surgical-approach TAVI from May 2009 to September 2017 were analyzed. Patients were allocated in 2 groups according to the approach. The primary end point was the 30-day composite of death of any cause, need for open surgery, tamponade, stroke, major or life-threatening bleeding, stage 2 or 3 acute kidney injury, coronary obstruction, or major vascular complications. During the study period, 104 patients underwent transthoracic TAVI (transapical: 60.6%, transaortic: 39.4%) whereas 87 patients underwent transarterial TAVI (subclavian: 83.9%, transcarotid: 16.1%). Logistic EuroSCORE I tended to be higher in transthoracic-TAVI recipients. In-hospital and 30-day composite end point rates were 25.0% and 11.5% (p = 0.025), and 26.0% and 14.9% (p = 0.075) for the transthoracic and transarterial cohorts, respectively. Propensity score-adjusted logistic regression demonstrated no significant detrimental association between the 30-day composite end point and transthoracic access (odds ratio 2.12 95% confidence interval 0.70 to 6.42; p = 0.18). Transarterial TAVI was associated with a shorter length of stay (median: 6 vs 7 days, p <0.001). TAVI approach was not an independent predictor of midterm mortality. In conclusion, nontransfemoral transarterial-approach TAVI is safe, feasible, and associated with comparable rates of major perioperative complications, and midterm mortality compared with transthoracic-approach TAVI.

Role of CT scan in Diagnosis of Patients with Suspected Subacute Intestinal Obstruction

Background: Intestinal obstruction is defined as mechanical or functional obstruction of the intestines which prevents the normal passage of the products of digestion. Present study was performed to study the role of Computerized Tomography (CT) in Diagnosis of patients with suspected subacute intestinal obstruction (SAIO), to find out site & cause of obstruction and to diagnose complications of obstruction. Subjects and Methods: This study was conducted at Department of Radiodiagnosis, Gujarat Adani Institute of Medical Science, Bhuj, Kutch, Gujarat. Total number of 15 patients with SAIO having equivocal findings on USG was included in this study. All the statistical tests were performed in SPSS version 15 software. Results: Age of the patients in the study range between 14 to 70 years. Out of 15 were 8 male & 7 female patients. On CT scan all 15 patients were found to have obstruction with 12 patients having mechanical obstruction & 3 patients having pseudo obstruction secondary to appendicitis, jejunal perforation. CT scan correctly diagnosed intestinal obstruction with its cause in 14 out of 15 patients. Most common cause of SAIO was ileal stricture followed by intussusceptions. Conclusion: The findings of the study show that CT is a valuable diagnostic procedure in patients with subacute intestinal obstruction with high sensitivity. It is a problem-solving tool in equivocal cases.

Persistence and appearance of vesicoureteral reflux/obstruction following open reimplantation for vesicoureteral reflux

Introduction: Appearance or persistence of vesicoureteral reflux (VUR) and other obstructive complications after open reimplantation of ureters is well known and up to 7.5% of cases require reoperation. In this study, we have assessed children presenting with recurrent urinary tract infection (UTI) following open reimplantation for VUR. Materials and Methods: We retrospectively collected hospital data of 14 children referred to us for management of recurrent UTIs following open ureteric reimplantation for vesicoureteric reflux from January 2006 to December 2015. Results: Fourteen children presented to our center at a mean age of 31.85 ± 10.17 months. The mean serum creatinine was 0.77 ± 0.26 mg% (range 0.5–1.3). Urine culture was positive in all with Escherichia coli being the most common organism grown on culture. Two children had obstruction at the vesicoureteric junction, and the remaining twelve children had 14 ureteral units with VUR. Two children underwent reimplantation into Boari flap, five underwent open reimplantation, and the remaining seven underwent endoscopic Deflux injection. Repeat voiding cystourethrogram done within 1 year of surgery revealed no VUR in any child. Conclusions: Appearance or persistence of VUR and obstructive complications after open reimplantation surgery is a matter of great concern for the parents of these children as well as the treating pediatric urologists. Appropriately selected open/endoscopic treatment can help in resolving these complications.

The Outcome of Transvesical Prostatectomy—A Multicenter Retrospective Study

Background: Benign Prostatic Hyperplasia (BPH) is one of the commonest causes of lower obstructive uropathy and usually presents with lower urinary tract symptoms. However, in developing nations, the presentation is late often large prostate and associated complications of bladder outlet obstruction (diverticulae, stones, impaired renal function etc.) warranting open prostatectomy. Objective: The objective of this study is to share our experience of perioperative outcomes of open transvesical prostatectomy over a year involving two referral centers in Monrovia Liberia. Methodology: This was a retrospective study performed at The John F. Kennedy Medical Center and the Saint Joseph Catholic Hospital involving a total of 31 patients. Results: The mean age was 64.6 years (SD = 9.03) with a range 52 - 85 years. The study showed that 54.8% (17/31) of patients had preoperative catheter. The maximum duration of Catheter was greater than 4 weeks with a mean duration of 3.17 weeks. The mean hemoglobin was 11.30 g/dl. The commonest presenting complication was urinary retention at 25.8% (8/31) followed by hematuria 16.1% (5/31). Hypertension 41.9% (13/31) and diabetes 6.5% (/31) were the commonest comorbidity. The rate of postoperative complication was 38.7% with the commonest being surgical site infection 16.1% (5/31) and clot retentions 9.7% (3/31). There was a high rate of transfusion was 77.4% (24/31) patients. Up to about 13% (4/32) patients had coexisting stricture with 6.5% (2/31) patients treated with urethroplasty and 6.5% (2/31) patients treated by dilatation. The mortality rate was 6.5% (2/31) from renal impairment and severe sepsis. Conclusion: BPH is a common cause of lower obstructive uropathy. Most patients present with complications of the disease such as refractory symptoms, bladder stones or diverticulae necessitating surgery. However, due to the absence of endourological equipments in most parts of Africa and the large prostate at presentation, most settings consider open transvesical prostatectomy as a viable option. The perioperative morbidity is relatively higher, but the outcome remains acceptable.

Feasibility of aorta after endarterectomy as middle hepatic vein reconstruction in living donor liver transplantation

Introduction: Cryopreserved iliac vein, Polytetrafluoroethylene (PTFE) grafts, and cryopreserved aorta without endarterectomy have been used as middle hepatic vein (MHV) conduits for right liver graft in living donor liver transplantation, but each has advantages and disadvantages. In this study, we started to use aorta after endarterectomy (AoE) without any additional patches and checked patency after engraftment. Method: From January 2015 to June 2018, 111 cases of adult LDLT with modified right lobe grafts using aorta after endarterectomy were performed at Asan Medical Center. Retrospective analysis of patency in these recipients were carried out and compared with control group who received iliac vein (n=436) during the same study period. All vessels were stored and prepared as cryopreservation. Patency of reconstructed MHV was assessed by computed tomography (CT) which was routinely followed at every week during in-hospital stay and at 1, 3, 6, and 12 months after LDLT. Result: Clinically significant stenosis of MHV requiring interventional stenting was occurred in three patients (2.7%) in AoE group, not significantly different from seventeen patients (3.9%) in iliac vein group (p=0.778). Aorta after endarterectomy showed 3-month patency rate of 91.6% and 1-year patency rate of 63.5%. Mean patency time of MHV with AoE 21.4±1.9 months. When compared to iliac vein group, which demonstrated 3-month and 1-year patency rate as 90.0% and 37.3%, respectively, AoE proved superior patency outcome (p=0.001). Mean patency time of iliac vein was 19.6±2.2 months. Conclusion: In this study, AoE showed an acceptable outcome and even better patency compared to iliac vein. Clinically significant complication of stenosis or obstruction of MHV was fairly low. Larger diameter with well-matched thickness to MHV branches, not requiring iliac artery patch, is of great advantage in AoE as interposition graft.

Vedolizumab treatment in a patient with X-linked agammaglobulinemia, is it safe and efficient?

Çekiç Ş, Özgür T, Karalı Y, Özkan T, Kılıç SŞ. Vedolizumab treatment in a patient with X-linked agammaglobulinemia, is it safe and efficient? Turk J Pediatr 2019; 61: 937-940. The loss of inflammatory regulation resulting from the absence of B-lymphocytes leads to a risk for autoimmune and autoinflammatory complications. There is no data on the use of Vedolizumab in patients with X-linked agammaglobulinemia (XLA) as well as children with another primary immunodeficiency (PID) diseases. A 4-year-old boy was admitted to our clinic with a history of recurrent respiratory tract infections. He was diagnosed with XLA based on extremely low immunoglobulins, very low level of B cells, genetic mutation of BTK gene, and family history. At the age of 8, he suffered from intermittent fever attacks, abdominal pain, weakness, oral aft, and weight loss. His clinical and laboratory features were consistent with inflammatory bowel disease. Histopathological examination of the biopsy material obtained from terminal ileum, colon and cecum showed Crohn`s disease. Initially, he was treated with prednisolone and infliximab. Because of the lack of response, infliximab treatment was switched to adalimumab. Terminal ileum was resected to relieve obstruction complication. Although he had been treated with adalimumab, a significant improvement was not observed. Vedolizumab (Entyvio™), a humanized monoclonal antibody α4β7 integrin-receptor antagonist, was commenced. After treatment with vedolizumab, his fever and abdominal pain attacks reduced, his total daily calorie intake increased and weight gain improved. He began to walk again and continued his school education properly. No side effects were observed in 18 months. This is the first immunocompromised child treated with vedolizumab. The symptoms of the patient receded and no side effect were seen during the treatment.

Perioperative manometric studies in laparoscopic Watson’s repair versus Nissen’s fundoplication

Background: Hiatus Hernia (HH) and GERD are common upper gastroesophageal disorders, The Nissen`s fundoplication is one of the most effective and commonly used surgical techniques in management of both GERD and hiatus hernia (HH). many surgeons are searching for alternative procedures due to the mechanical obstructive effects of Nissen's fundoplication, one of these procedures is partial anterior fundoplication (Watson’s repair).Methods: Eighty two patients, diagnosed to have GERD and/or HH, were scheduled for present study for laparoscopic anti-reflux surgery. They were randomized to either Watson’s repair (anterior partial fundoplication) (group I) or Nissen repair (group II) in the period between June 2012 and March 2017. Forty two patients for group I and forty patients were included in group II. Group I had partial anterior fundoplication and group II had Nissen's fundoplication. Follow up for all patients included in our study was scheduled at (2, 4weeks and 3, 6, 12months postoperatively) both subjectively - using a standardized scoring system for reflux symptoms (heartburn, regurgitation and dysphagia), gas bloating and objectively-using esophago-gastroscopy at 6ms and 12ms postoperatively, esophageal manometry, 24hours PH monitoring at 6ms and 12ms post operatively.Results: Three cases were excluded from the study because they were converted to open procedure, one of group I and two of group II. Mean operative time was significantly shorter in group I. As regarding to reflux symptoms (heartburn and regurgitation) Nissen was significantly higher in control of reflux symptoms at 3months but at 6, 12months Nissen still higher but without a clear significant difference. On the opposite side dysphagia was significantly higher in Nissen group than in Watson group at 3months and remained higher at 6,12months but with no significant difference, also gas related symptoms were higher in Nissen group than in Watson group all the time of follow up. Objectively, esophagitis improved to a similar extent in both groups. Watson was less effective in improving LES characters, and 24hours PH parameters in comparison to Nissen group but without any significant difference in both groups.Conclusions: Partial anterior fundoplication (Watson repair) can be safe, effective and simple alternative procedure for Nissen's fundoplication with less obstructive symptoms and complications.

Частота и факторы риска развития инфравезикальной обструкции вследствие хирургического лечения доброкачественной гиперплазии предстательной железы

Benign prostatic hyperplasia (BPH) is one of the most common diseases of men elderly and senile age. The main surgical methods of treatment for BPH are transurethral resection and open prostatectomy. In some cases surgical treatment of BPH is accompanied by the development of postoperative complications leading to recurrence of the infravesical obstruction. Currently, there are no strict guidelines for selection of an optimal method of correction of late obstructive complications. This study highlights the main existing theories concerning development of urethral strictures and bladder neck contracture.

Incomplete intestinal obstruction as the possible main complaint in Behcet\u2019s disease after surgery for recurrent abdominal aortic pseudoaneurysms: a case report and literature review

BackgroundBehcet’s disease (BD) is a systemic vasculitis characterized by oral and genital aphthosis, and ocular and skin lesions. The disease is involved in vascular, gastrointestinal, and central nervous systems. Vasculitis may exacerbate fatal problems, such as anastomotic pseudoaneurysms. If the mesenteric vessels are involved, severe abdominal symptoms such as intestinal obstruction may occur.Case presentationThis case report describes a young female patient who suffered from BD with recurrent abdominal aortic pseudoaneurysms, as well as deep venous thrombosis and subsequent complications of incomplete intestinal obstruction. This patient first underwent stent grafting, which was followed by rupture of two newly formed anastomotic pseudoaneurysms within six months. Emergency open surgical repair (OSR) was then performed on the ruptured pseudoaneurysms. Thrombosis and incomplete ileus occurred five months after surgery. This case was unique due to the presence of incomplete intestinal obstruction being the possible main complaint for a patient with Behcet’s disease, and it is the first ever case to be reported.ConclusionIntestinal obstruction may present as the possible main complaint in BD. Careful and attentive strategy should be carried out to prevent fatal outcomes.

Dyspnea Revealing an Uncommon Complication of Kidney Obstruction: Urinothorax.

Dyspnea Revealing an Uncommon Complication of Kidney Obstruction: Urinothorax.

Reprint of: Parastomal hernia: Surgical management

Parastomal hernia is a common clinical problem that is difficult to manage. Although surgical repair is recommended for the majority of other incisional hernias to prevent the complications of incarceration, obstruction, or strangulation, most authors recommend nonoperative management of parastomal hernias. Surgical management is usually reserved for those patients whose parastomal hernia results in intractable difficulty maintaining an effective stoma appliance or who develop a severe complication. This article reviews the nonoperative and operative management of parastomal hernias by fascial repair and stomal relocation. Unfortunately, no randomized trials exist to guide the surgeon in the choice between the accepted nonoperative and surgical management options. Fascial repair without a prosthetic should probably be used only in the rarest of circumstances. If stoma relocation is selected, the stoma should be relocated to the opposite side of the abdominal wall and reconstructed using techniques associated with the lowest risk of stoma-related complications and parastomal hernia. However, the best outcomes may require the use of a prosthetic either to either repair or prevent a parastomal hernia.

A Comparison of Open Standard Esophageal Stent and Anti-reflux Stent with Valve: A Meta-Analysis of Randomized Controlled Trials

Introduction: Esophageal cancer usually presents at a later stage with dysphagia. Stent placement is one of the palliative treatment modalities to relieve dysphagia. Gastroesophageal reflux (GERD) is one of the most common adverse outcomes associated with stents, especially in cancers involving the esophagogastric junction and gastric cardia. While traditionally standard stents (SS) have been used to relieve dysphagia, intuitively antireflux stents (ARS) may have advantage over SS for relief of dysphagia and GERD due to their design. Therefore, the aim of this study was to compare the SS and ARS in terms of their efficacy, safety and complications. Methods: Electronic databases were searched for English language randomized clinical trials (RCT) since inception through April 2018. Random effects model was used to perform meta-analysis. The major outcomes studied were the improvement in dysphagia, GERD scores, which were reported as standardized mean difference (SMD). The risk of stent migration, bleeding and obstruction were reported as odds ratio (OR). Results: A total of eight RCTs were available for inclusion in the meta-analysis. Compared to the SS, the ARS showed a trend towards reduction in the dysphagia score but it did not reach a statistical significance [Standardized mean difference (SMD): -0.33 (-0.71,0.05); P=0.09, I2: 37%]. There was no statistical difference in the GERD scores between the two types of stents [(SMD): -0.17 (-0.78,0.45); P=0.008, I2: 74%]. Compared to SS, ARS showed no statistical difference in the risk of stent migration [OR: 1.37 (0.66, 2.83); P=0.40, I2: 0 %], bleeding [OR: 1.43 (0.40, 5.13); P=0.59, I2: 0 %]. and obstruction [OR: 1.66 (0.60, 4.60); P=0.33, I2: 0 %]. Conclusion: Our meta-analysis showed that the standard stent and anti-reflux stent were similar in terms of outcomes and risk of complications. Authors believe both anti-reflux and standard stents could be used in clinical practice as per the availability of clinical expertise, cost and patient’s choice. Based on our results, more RCTs with higher number of patients need to be studied in future to compare standard versus anti-reflux stents.346_A Figure 1. Forest Plot comparing Standardized Mean Difference in Dysphagia and GERD between Anti-reflux stent and Standard stent.346_B Figure 2. Forest Plot comparing complications of stent migration, bleeding and obstruction between Anti-reflux and Standard stent

An Unusual Complication of Complete Esophageal Obstruction Following Endoscopic Variceal Banding

An Unusual Complication of Complete Esophageal Obstruction Following Endoscopic Variceal Banding

Tubular vesicopyelostomy for the management of types 2 and 3 (long-segment) ureteric stenosis after kidney transplantation.

Late ureteral stenosis following kidney transplantation needs immediate correction in order to protect allograft function and requires a complicated surgical procedure. In this study, we present the long-term results of tubular bladder reconfiguration and cystopyelostomy (tubular vesicopyelostomy), an innovative and practical procedure for the management of long-segment ureteric stenosis (types 2 and 3) after transplantation. Between 2002 and 2017, 722 kidney transplant patients were monitored at the University of Medical Sciences, Bozyaka Organ Transplantation and Research Center. Twenty-eight of these patients underwent tubular vesicopyelostomy operation; 17 male and 11 female patients with a mean age of 45.6 ± 10.5 years. Time to surgical intervention for urinary tract obstruction was 122.5 ± 114.7 months. The mean serum creatinine values previous to and 3 days following the tubular vesicopyelostomy operation were 3.46 ± 1.5 mg/dL and 1.75 ± 0.7 mg/dL, respectively (p < 0.0001). Within a mean follow-up period of 55.1 ± 40.9 months, functional grafts were recorded in 22 patients with a mean serum creatinine value of 1.92 ± 0.8 mg/dL. Only one patient developed anastomotic stenosis after the tubular vesicopyelostomy procedure, giving an overall success rate for tubular vesicopyelostomy of 96.4%. Six patients returned to hemodialysis. In five, the underlying etiology was not related to recurrent obstruction or surgical complications. Sixteen patients underwent allograft biopsy after the operation, but features of tubulointerstitial nephritis were seen in only one. Tubular vesicopyelostomy operation is a safe and successful method for the surgical treatment of late and complicated ureteral obstructions with excellent long-term results. It may be a good, practical alternative to other more sophisticated surgical options.