Flank Approach Research Articles

Successful small intestinal resection and anastomosis in a late term broodmare with colic via a standing left flank laparotomy

SummaryA late term broodmare presented with low‐grade intestinal colic. Clinical findings were consistent with a small intestinal lesion requiring surgical intervention. The risks of general anaesthesia to the fetus, combined with clinical findings in an otherwise quiet natured horse influenced the decision to choose an alternative standing left flank approach first. A small intestinal resection and anastomosis was performed successfully and the mare delivered a healthy foal without complications a month later. Standing colic surgery might be a preferred alternative to general anaesthesia in certain circumstances as discussed in this case report.

SURGICAL MANAGEMENT BY STANDING LAPAROSCOPY AND INGUINAL CELIOTOMY APPROACH OF THE CRYPTORCHID CANADIAN PONY STALLION – CASE REPORT

SURGICAL MANAGEMENT BY STANDING LAPAROSCOPY AND INGUINAL CELIOTOMY APPROACH OF THE CRYPTORCHID CANADIAN PONY STALLION – CASE REPORT Cornel IGNA1*, Roxana DASCALU1, Daniel BUMB1, Bogdan Sicoe1, Larisa SCHUSZLER1 1 Banat’s University of Agricultural Science and Veterinary Medicine, “King Michael I of Romania” from Timisoara, Romania *Corresponding author, e-mail: ignacornel@gmail.com Keywords: cryptorchidectomy, inguinal celiotomy, laparoscopic, stallion pony Introduction: Laparoscopic surgery has become an accepted method of identification and removal of intra-abdominal testes in the horse. Wilson and Madison – 1989 describe the use of laparoscopy to diagnose an abdominal retained testes. Since then numerous laparoscopic cryptorchidectomy techniques have been described. Aims: In the encountered specialty literature there are few reports in which standing laparoscopic cryptorchidectomy could not be performed in stallions including miniature horse too. Because there are no informations regarding laparoscopic surgery in large animals in romanian literature this report describes the surgical management of a Canadian pony diagnosed with partial abdominal unilaterally cryptorchidism at which laparoscopic castration has failed and the removal of the retained testicle has been made through inguinal celiotomy. Materials and Methods: A 4-year-old unilaterally cryptorchid Canadian pony was admitted for castration. The left testis was in the scrotum, but neither the right testis nor the right epididymis could be located by external palpation of the right inguinal canal. The proposed treatment was laparoscopic cryptorchidectomy with pony standing in stock. With a long-handled forceps inserted into the abdominal cavity, the testis cord is gently grasped and moderate traction without success in bringing the testicle into the abdomen - retained testis. After the failure of laparascopic cryptorchidectomy but having an exact diagnosis - partial abdominal unilaterally cryptorchidism, we have proceeded to open cryptorchidectomy via inguinal approach with pony anesthetized and positioned in dorsal recumbency. Results: This case report reveals that the major disadvantage of the cryptorchidectomy by flank approach is the inability to remove an inguinally retained testis. Conclusion: If the location of the testis is unknown, the standing laparoscopic diagnose can be decisive. Cryptorchidectomy via inguinal approach and noninvasive method for identifying and everting the vaginal process by traction of the inguinal extension of the gubernaculum testis are commonly facile procedure.

Outcome Following Partial Unilateral Hysterectomy by Standing Flank Approach in Dairy Cattle.

To describe the clinical findings, surgical treatment, and long-term outcome of dairy cattle undergoing partial hysterectomy with or without unilateral ovariectomy. Retrospective case series. Dairy cattle (n = 7). Medical records (June 2007-June 2014) of dairy cattle that had partial hysterectomy with or without ipsilateral ovariectomy were reviewed. Follow-up data were obtained by telephone interviews with owners and referring veterinarians between 6 months and 7 years following discharge. Seven dairy cattle met the inclusion criteria. Diagnoses made intra- or postoperatively were ovarian abscess with multiorgan adhesions (4 cows), segmental aplasia of the uterus (2 cows), and uterine lymphosarcoma (1 cow). Partial hysterectomy with or without unilateral ovariectomy was performed without surgical complications by standing flank approach. All cows were successfully discharged from the hospital (short-term prognosis). Five cows became pregnant, and 4 delivered live calves and had a satisfactory productive life without long-term complications. Partial hysterectomy by standing flank approach should be considered as a viable treatment option for unilateral ovarian or uterine problems in dairy cattle. Cattle undergoing partial hysterectomy with or without ipsilateral ovariectomy are capable of satisfactory reproduction and milk production after surgery with no short- or long-term complications.

Unilateral flank ovariohysterectomy in guinea pigs (Cavia porcellus)

AIMS: To describe a simple, minimally invasive method of ovariohysterectomy via a unilateral flank approach in guinea pigs, for use in routine desexing of healthy female guinea pigs or treatment of ovarian cysts.METHODS: The subjects of this retrospective study were 41 client-owned guinea pigs submitted for routine desexing or treatment of ovarian cysts. They included 16 healthy female guinea pigs aged 8–12 months (Group 1), and 15 females aged from 9 months to 3 years (Group 2), and 10 females aged from 3 to 7 years (Group 3) with different-sized ovarian cysts. Prior to surgery, the animals received clinical examination, blood testing (complete blood count and serum biochemistry profile) and examination of the abdomen using ultrasonography, to assess the condition of the reproductive tract and ensure the guinea pigs were fit for surgery. Ovariohysterectomy was performed via a unilateral flank incision made close to the erector spinae muscle starting approximately 1 cm caudal to the last rib. Both ovaries, uterine horns, and the uterine cervix were localised, ligated, and dissected through this unilateral retroperitoneal incision.RESULTS: Ovariohysterectomy was successfully completed via a single flank incision in 38/41 (93%) guinea pigs. Three guinea pigs with ovarian cysts from Group 3, which were >6 years old died during surgery due to circulatory and respiratory failure under anaesthesia. In the remaining 38 cases, surgery proceeded without complications. A further two guinea pigs from Group 3 were reluctant to move or eat for the first 3 days after surgery but recovered after provision of supportive care. All 38 animals fully recovered and wound healing was normal.CONCLUSIONS: This is the first report of ovariohysterectomy via a unilateral flank incision in guinea pigs. This approach is a simple, minimally invasive and safe alternative to the midline or bilateral flank approaches currently used for surgery of the reproductive tract in guinea pigs.

Flank or midline ovariohysterectomy in the cat?

Both the left flank and the midline approach may be used for ovariohysterectomy in the cat, and either approach may be appropriate in most cases. However, recent research suggests that the midline approach may be less painful, and therefore should be considered more often. Definite advantages of the midline approach include improved exteriorisation of the right ovary and of the gravid uterus, particularly in late pregnancy, but the risks of wound contamination and of dehiscence must be remembered, particularly in feral cats. It also avoids the coat colour changes seen if the flank is shaved in Siamese or Burmese cats. The left flank approach sometimes makes elevation of the right ovary or exteriorisation of the uterine bifurcation problematic. It is less useful in the heavily pregnant animal, in which a large flank incision would be needed and would cause more muscle damage. However, it is preferable in lactating individuals, may be preferred in the management of feline fibroadenomatous mammary hyperplasia, and has some advantages in stray cat spay projects.

Effect of age and surgical approach on perioperative wound complication following ovariohysterectomy in shelter-housed cats in Australia.

ObjectivesThe aim of the study was to investigate the effects of age and/or surgical approach on perioperative wound complication following ovariohysterectomy (OHE).MethodsA retrospective search of perioperative monitoring records from a shelter desexing program was conducted to identify cats that underwent OHE between 1 June 2010 and 31 December 2012 inclusive. A wound complication was defined as gross observation of inflammation or wound dehiscence at the surgical site in the 5 day postoperative period. Cases were grouped according to age (≤12 weeks or >12 weeks) and surgical approach (flank or midline). Stratified analyses were conducted to evaluate the association between surgical approach and wound complications, after adjusting for age. Mantel–Haenszel adjusted risk ratio, Cochran–Mantel–Haenszel test statistic and their 95% confidence intervals were presented.ResultsA total of 312 cases met the study criteria. The overall wound complication risk was low (6.09%) and was not related to age. A midline approach was associated with a 4.59-times increased risk of wound complication, compared with a flank approach in cats up to 12 weeks of age (P = 0.015) but not in older cats.Conclusions and relevanceThese findings support the practice of prepubertal desexing for cats.

Incidentally Detected Primary Giant Renal Cystic Enchinococcosis in a Young Patient: An Underestimated Entity?

Echinococcosis is a parasitic infestation caused by Echinococcus granulosus and is an endemic disease in many parts of world. The symptoms and signs depend on the location and size of the cyst. Renal cystic echinococcosis or hydatid cyst (HC) disease of the kidney is extremely rare and constitutes only 2-4% of all cases of hydatid disease (HD). We present a 39-year-old male patient who was referred to our outpatient clinic with cystic right kidney mass that was incidentally diagnosed during hepatobiliary ultrasound for chronic hepatitis B evaluation. Routine blood tests were normal without eosinophilia. Indirect haemagglutination test was negative. Abdominal kidneys, ureters, and bladder X-ray showed an 83×95 mm sized curvilinear calcification in the right upper abdominal quadrant. Abdominal computed tomography scan and magnetic resonance imaging demonstrated a 10x9x10 cm sized cystic mass arising from the middle pole of the right kidney, destructing the whole upper pole and extending into the liver. Daughter vesicles were present in the cystic lesion suggesting renal HD. Right retroperitoneal exploration with flank approach and right radical nephrectomy was performed without any complications. Pathology confirmed HC lesion. Following surgery, albendazole 400 mg per os twice daily for 4 weeks was suggested.

Primary Retroperitoneal Inflammatory Myofibroblastic Tumour.

Inflammatory myofibroblastic tumours are uncommon neoplasms of unknown aetiology. They commonly involve the lung and their occurrence in the retroperitoneum can be considered anecdotal. A 30-year-old female presented with dull aching, intermittent pain in the right flank for six months. There was a history of weight loss of 4kg over six months. There was no history of any medical co-morbidity or past surgical intervention. The clinical examination was normal. Haemogram revealed increased erythrocyte sedimentation rate but the serum biochemistry was within normal limits. Ultrasound examination of the abdomen was suggestive of a heterogeneous mass in close relation to the lower pole of the right kidney. Contrast enhanced CT scan revealed a 5 cm x 6 cm mass in the retroperitoneum, anterior to the right psoas muscle and in close relation to the lower pole of the right kidney. The mass showed contrast enhancement in the arterial phase and the enhancement persisted even in the delayed scan. There was evidence of fat stranding around the mass [Table/Fig-1a&b]. The possibility of a retroperitoneal sarcoma, Castleman’s disease and an inflammatory mass were considered. As the diagnosis was not certain, a CT guided tru-cut biopsy from the mass was performed which suggestive of an inflammatory myofibroblastic tumour. The metastatic work-up was negative. The patient was taken up for open surgical excision of the mass via right flank approach. At surgery, the mass was well circumscribed and could be separated from the kidney and the inferior venacava by blunt and sharp dissection [Table/Fig-2a-d]. The histopathological examination shows polymorphic cells composed of lymphocytes and plasma cells along with plump spindle cells arranged in fasicular pattern which is consistent with the diagnosis of inflammatory myofibroblastic tumour [Table/Fig-3]. The patient made an uneventful recovery and is well at a follow up of six months. [Table/Fig-1]: (a) Contrast enhanced CT scan showing the enhancing tumour (yellow arrow) in close proximity to the lower pole of the right kidney (red arrow) and inferior venacava. There was evidence of fat stranding all around the tumour. (b) The lower part of the ... [Table/Fig-2]: (a) At surgery, the tumour could be separated from the kidney. (b) The tumour, after mobilisation following blunt and sharp dissection. (c) The tumour after excision. (d) The cut section of the tumour [Table/Fig-3]: The histopathological picture of the tumour revealing polymorphic cells composed of lymphocytes and plasma cells along with plump spindle cells arranged in fasicular pattern (Haematoxylin & Eosin, 100X) Inflammatory myofibroblastic tumour, also known as pseudo tumour, plasma cell granuloma is a rare neoplasm. It is presumed to occur as a result of trauma, infection, previous surgical intervention, etc [1,2] and most often involves the bladder [3]. The patients usually present with non specific symptoms like pain abdomen, loss of weight, fever. Anaemia, elevated counts and erythrocyte sedimentation rate can also be seen. At imaging, the tumour usually shows heterogeneous enhancement but again, there are no specific features. Of late, Positron emission tomography has also been reported to be helpful. The tumour, by the virtue of associated inflammation, has been found to have high standardized uptake value on a 18F- fluorodeoxyglucose positron emission tomography. Though these findings support the diagnosis, histopathological examination along with immunohistochemistry remains the confirmatory investigation [4,5]. The retroperitoneal inflammatory myofibroblastic tumours are extremely rare neoplasms having non-specific symptoms and imaging findings. Surgical removal remains the mainstay of treatment.

Retroperitoneoscopic live donor nephrectomy: Review of the first 50 cases at Tygerberg Hospital, Cape Town, South Africa

Changing from an open to a laparoscopic live renal donor programme poses challenges and may affect donor and graft outcomes. To evaluate donor safety and graft outcomes for the first 50 retroperitoneoscopic live donor nephrectomies performed at Tygerberg Hospital, Cape Town, South Africa. The procedures were performed by a single surgeon from 8 April 2008 to 3 April 2012. Operative and anatomical data were prospectively collected. A flank approach with lateral and posterior placements was used. Vascular control was achieved with Hem-o-lok clips in the majority of cases. The mean age of the donors was 31.5 years (range 18 - 50), 28 (56.0%) were male, and the left kidney was harvested in 28 (56.0%) of cases. The mean operating time was 149.8 minutes (range 75 - 250), mean warm ischaemic time (WIT) 181.3 seconds (107 - 630), mean blood loss 139.7 ml (5 - 700) and mean hospital stay 3.2 days (2 - 5). Mean WIT was significantly longer for right-sided than left-sided nephrectomy (213 v. 162 seconds). In two right-sided cases the renal vein was too short and vena profunda femoris was used to create length. No donor received a blood transfusion. Comparing the last 25 with the first 25 cases showed a significant decrease in mean WIT (158 v. 204 seconds) and operating time (128 v. 172 minutes). No major complications occurred. Our initial 50 retroperitoneoscopic live donor nephrectomies were performed without major complications. Donor safety was maintained during the early learning curve of the transition to minimal-access donor nephrectomy.

English

The study was carried out to determine the histological characterizations of wound healing in cats. For the purpose, 24 feral/stray with mean age of 7 to 33 months and body weight between 1.72 to 4.02 kg cats were selected and divided in 4 subgroups. Ovariohysterectomy was performed in all the cats. The cats operated through flank approach healed earlier and histological characterization showed better wound healing through flank in adult cats. All the cats did not heal on the 12th day, and the trend of healing showed bit maturation. Parameters studied are histological characterization of wound healing were acute inflammation, chronic inflammation, granulation tissue amount, granulation tissue amount and fibroblast maturation, collagen deposition, re-epithelization and neovascularization.    Key words: Cats, ovariohysterectomy, flank, midline, healing.  

Assessment of Postoperative Pain in Cats After Ovariectomy by Laparoscopy, Median Celiotomy, or Flank Laparotomy

To compare postoperative pain, duration of surgery, and duration of anesthesia for 3 methods of ovariectomy in cats: (1) conventional ventral median open approach (Midline), (2) right flank approach (Flank), and (3) median 2-portal laparoscopic procedure (Lap). Randomized, prospective clinical trial. Healthy, sexually intact female cats (n = 60). Cats were randomly assigned to 1 of 3 groups: Midline (n = 20), Flank (20), and Lap (20) were evaluated 1, 2, 4, 6, and 12 hours after endotracheal extubation. Postoperative pain was scored using the 4A-vet pain scale that combines a subjective numerical pain rating and objective scoring of physiologic and behavioral variables including the response to stimulation of the surgical site. Pain scores (PS) were compared between groups. There was a significant difference in the PS between groups. PS for Midline and Flank were not significantly different but were both significantly higher compared with Lap. Depending on time, 5-20% of the cats had intense postoperative pain in both Midline and Flank groups. None of the Lap cats had intense postoperative pain. Laparoscopic ovariectomy, although slower, appeared less painful compared with conventional ventral midline and flank ovariectomy. Postoperative pain did not differ significantly between midline and flank groups.

Primary Mature Cystıc Teratoma Mimickıng an Adrenal Mass in an Adult Male Patient

Teratomas are bizarre neoplasms derived from embryonic tissues that are typically found only in the gonadal and sacrococcygeal regions of adults. Primary retroperitoneal teratomas are rare and present challenging management options. We report a case of a unilateral primary retroperitoneal mature cystic teratoma mimicking an adrenal mass in a 54-year-old male patient. Complete resection of the adrenal mass was performed by the flank approach by using the 11th rib resection. Because of the risk of malignancy, follow-up radiographic studies were performed to ensure the oncologic efficacy of resection. The patient has been free of recurrence for longer than 12 months.

Case study: the use of a salvage (low flank) caesarean section to remove an emphysematous calf

Obstetrical procedures are common place in dairy practice in the UK, and both fetotomy to allow delivery per vaginum and a standing left paralumbar celiotomy approach for caesarean section are standard techniques. In some clinical presentations, neither of these techniques may be appropriate for a complicated dystocia. In some cases, where a calving has been missed for some days or where a second calf is found to be present some days after the delivery of its twin, euthanasia of the cow may be considered to be the only option available, since without its removal, the putrefaction of the fetus may result in life-threatening toxaemia to the cow. This article describes the use of a ventrolateral (low flank) approach to caesarean section as an alternative option in such a case.

Health-related quality of life in long-term survivors after renal cancer treatment

Objective. The most important outcome of renal cell carcinoma (RCC) treatment is survival. However, all cancer treatment should evaluate the health-related quality of life (HRQoL) outcome of the treatment. This has not been sufficiently documented in RCC. The aim of this investigation was therefore to document the HRQoL outcome of RCC. Material and methods. All 413 RCC patients treated with radical or partial nephrectomy at Haukeland University Hospital, Norway, during the period 1997--2010 were included. After exclusions, invitations to participate were mailed to 260 patients; 185 patients (71%) returned the questionnaires. In addition, a cohort of general head and neck squamous cell carcinoma (HNSCC) patients, a cohort of laryngectomized HNSCC patients, and a cohort from the general population of Norway, were used to compare the RCC patients' HRQoL scores. Results. Performance status as measured by the American Society of Anesthesiologists (ASA) score and Eastern Cooperative Oncology Group (ECOG) classification at diagnosis showed an inverse relation to HRQoL [maximum coefficient of variation (CVmax) = 5.3%, p < 0.05]. Flank and open transabdominal approaches to RCC tumour resection were followed by reduced HRQoL compared with a general cohort of Norwegian citizens. However, the laparoscopically treated RCC patients had HRQoL scores at the level of the population. The indices “general health/QoL”, the functional indices, and the symptom indices “fatigue”, “pain”, “sleep”, “nausea and vomiting”, “constipation” and “diarrhoea” were particularly affected. Conclusion. The results show that RCC patients, and in particular those treated by a flank approach but not those treated by minimal invasive surgery, have a multifacetedly reduced HRQoL compared to a general population cohort.

Puerperal development of ewes following dystocia: a retrospective analysis of two approaches to caesarean section

The objective of this study was to retrospectively analyse the puerperal development of ewes referred to a veterinary teaching hospital following caesarean section in comparison with assisted parturition. Laparotomy was performed either via left flank incision (group 1, n=86) or ventral mid-line approach (group 2, n=33). Both groups were compared with ewes following non-surgical intervention (group 3, n=73). The overall fetal death rate was 41 per cent. There was no significant difference in fetal deaths between groups 1 and 2, but assisted delivery led to a higher number of liveborn lambs compared with caesarean section (P<0.05). Seven ewes (3.6 per cent) died or were euthanased on welfare grounds during caesarean surgery, and the overall maternal mortality rate following dystocia in the postpartum period was 10.9 per cent. While there was no significant difference between groups 1 and 2 in the percentage of ewes developing healing disorders, the complications that occurred were more severe after the left flank approach (P=0.04), and the mean hospitalisation period was significantly longer in group 1 than in group 2 (P<0.05), leading to the conclusion that ventral mid-line laparotomy has some advantages over a left flank approach.

Growth inhibition and radiosensitization of human papillomavirus (HPV) positive head and neck cancer (HNC) by epidermal growth factor receptor inhibition is mediated by apoptosis

PURPOSETo determine the mechanism by which HPV+ HNC cells and patient‐derived tumorgrafts are sensitive to growth inhibition and/or radiosensitization by cetuximab.METHODSFour cell lines and several direct‐from‐patient tumorgrafts validated for HPV expression were used in a subcutaneous flank approach using athymic Foxn1nu female mice. Apoptosis and cell cycle distribution were assessed by caspase activation, flow cytometry, and western blot.RESULTSCetuximab caused significant delay in cell proliferation (p&lt;0.005), decrease in colony formation (p&lt;0.026), and minimal radiosensitization. In both a cell line xenograft and a direct‐from‐patient tumorgraft model of HPV+ HNCs cetuximab resulted in significant tumor growth delay (median time to tumor quadrupling: 15 vs. 24 days, p=0.02; and 42 vs. 89 days, p=0.0001, respectively). When combined with radiation, cetuximab resulted in a significant increase in time to tumor quadrupling compared to either cetuximab or radiation alone (p&lt;0.001). Cetuximab's effects correlated with enhanced apoptosis and a G1 cell cycle arrest.CONCLUSIONSCetuximab is active against HPV+ HNC cells and primary tumors and shows modest radiosensitization. Increased apoptosis was seen following cetuximab treatment. Mechanisms of resistance and predictors of response to EGFR inhibition in HPV+ HNC are being investigated.

The effect of administering ketoprofen on the physiology and behavior of dairy cows following surgery to correct a left displaced abomasum

Surgical correction of left displaced abomasum (LDA) is common in lactating dairy cattle. Despite the growing acceptance that abdominal surgery is painful, few cows are administered analgesia following LDA surgery. The objective of this research was to examine the effect of administering a label dose of ketoprofen on physiological and behavioral indicators of pain in dairy cattle. Holstein cows were enrolled in a field study following LDA surgery. Surgery was performed using the standing right flank (RF) approach or the paramedian (PARA) approach. Using a triple-blind randomized trial, each animal was assigned to receive either 3mg of ketoprofen/kg of body weight or saline (the equivalent volume) by intramuscular injection immediately following surgery and 24h postoperatively. Physiological parameters (heart rate, respiration rate, and rumen motility), blood β-hydroxybutyrate (BHBA) levels, and an assessment of cow attitude were measured on the day of surgery, and at 2 follow-up visits (visit 1=3±0.9 d and visit 2=9±1.2 d postsurgery; n=175). Milk production and culling were recorded for all cows enrolled in the study. Producers assessed their cows’ attitudes and appetites daily for the first 3 d following surgery. A subset of cows (n=37) were fitted on the day of surgery with a 3-axis accelerometer on the hind leg to assess lying behavior. Continuous and binary outcome data were analyzed using multivariable mixed linear and mixed logistic models, respectively, with cow modeled as a random effect. Ketoprofen did not alter the physiological measures, BHBA levels, or behavioral outcomes measured. Cows subjected to RF surgery had longer lying times [model coefficient β=228.9min; 95% confidence interval (CI): 122.2 to 335.6] in the first 3 d following surgery, and lower heart rates (β=−9.4 beats/min; 95% CI: −12 to −6.9 beats/min) at the follow-up visits, compared with animals that underwent PARA surgery. Regardless of surgical procedure, BHBA decreased from surgery day to visit 1 (β=−1.9mmol/L; 95% CI: −2.1 to −1.7) and visit 2 (β=−2.0mmol/L; 95% CI: −0.2.2 to −1.8). Producer reports indicated that animals that received ketoprofen were more likely to begin eating when provided fresh feed during the first 3 d following surgery compared with those that received saline (odds ratio=4.8; 95% CI: 0.97 to 23.8). These results indicate that PARA surgery may be more painful relative to lying down than the RF approach. The apparent differences in appetite or attitude in cows that received ketoprofen reported by producers warrant further investigation.

Retroperitoneal laparoscopic versus open dismembered pyeloplasty for ureteropelvic junction obstruction

To compare classical open pyeloplasty with retroperitoneal laparoscopic pyeloplasty in effectiveness, potential advantages and complications. Between March 2006 and April 2010, 113 patients with ureteropelvic junction obstruction underwent retroperitoneal laparoscopic dismembered pyeloplasty were retrospectively compared with those of 59 patients who underwent open dismemberse pyeloplasty through a retroperitoneal flank approach. The Chi-square test was used for statistical analysis of qualitative data and the Student t-test for analysis of quantitative data. P < 0.05 was considered significant. Operative time was shorter in the retroperitoneal laparoscopic group (mean 125 min) compared to the open pyeloplasty group (mean 142 min, P < 0.05). Mean hospital stay was shorter in the retroperitoneal laparoscopic group (mean 6 days, compared to 9 days, open). Complication rates, including anastomotic urinary leakage, stenosis and infection, were 4.42% in retroperitoneoscopic compared to 6.78% open surgery. Anastomotic leakage was 3 cases in the retroperitoneoscopic group versus 1 case in the open group. Success, defined as improved ultrasonic or renographic parameters, with resolution of symptoms where discernable, was noted in 98.0% of the open group and 98.1% of the retroperitoneoscopic group with a mean follow up of 38.4 and 32.7 months, respectively. Retroperitoneal laparoscopic dismembered pyeloplasty in treatment of ureteropelvic junction obstruction is a minimally invasive, safe and effective therapy with short procedure time, less complications, and shorter convalescence.

Giant Renal Artery Aneurysms: Decision-Making Dilemmas

A case of a 10 cm giant renal artery aneurysm in an 81-year-old lady is herein reported. The patient presented as an incidental finding on an abdominal ultrasound with an aneurysm which was large, soft, egg-shell-like, and bilobular with a cauliflower-type pattern invading the parenchyma of the renal substance and extending caudally. A right nephrectomy was carried out, and the patient made an uneventful recovery. This paper reviews the options for treatment of giant renal artery aneurysms and highlights the benefit of a planned nephrectomy once there is adequate renal reserve in the opposite kidney using a midline approach for right-sided giant renal artery aneurysms and a left-sided flank approach for left-sided aneurysms.

Removal of ureteral calculi in two geldings via a standing flank approach

Two geldings, aged 11 and 17 years, were examined for treatment of ureteroliths located approximately 10 cm proximal to the bladder. Ureteral obstruction was an incidental finding in 1 horse that was referred because of urinary tract obstruction and a cystic calculus. This horse did not have clinical or laboratory evidence of renal failure, although severe hydronephrosis was evident on transabdominal ultrasonography. The second patient had a serum creatinine concentration of 6.3 mg/dL (reference range, 0.8 to 2.2 mg/dL) and mild hydronephrosis of the affected left kidney. In both patients, the obstructed ureter was exteriorized through a flank incision as a standing procedure, and the calculus was crushed and removed with a uterine biopsy forceps introduced through a ureterotomy approximately 25 cm proximal to the calculus. The cystic calculus was removed through a perineal urethrostomy by lithotripsy, piecemeal extraction, and lavage. The horse without azotemia developed pyelonephritis in the affected kidney and was euthanatized because of complications of a nephrectomy 13 months later. In the horse with azotemia, the serum creatinine concentration decreased after surgery, and the horse returned to its intended use. However, it was euthanatized approximately 2 years after surgery because of progressive renal failure, and a large nephrolith was found in the previously unobstructed right kidney. The technique used for ureterolith removal was successful in both horses in this report, did not require sophisticated equipment, and could be effective in the early stages of ureteral obstruction as a means of restoring urine flow and renal function. The outcome in the horse with advanced unilateral renal disease without azotemia would suggest that nephrectomy should be considered as a treatment in such patients.