Flank Incision Research Articles

Surgical Treatment of Persistent Type 2 Endoleaks, with Increase of the Aneurysm Sac: Indications and Technical Notes

Objective Unsolved type 2 endoleaks and aneurysmal sac increasing after endovascular aneurysm repair (EVAR) can be fixed with surgical sacotomy, ligation of the patent backbleeding vessels and preservation of the endograft. The aim of the paper is to highlight the technique as a feasible procedure in alternative to the removal of the graft. Materials and methods Four male patients whose aneurysm sac maximum transverse diameter had increased by 5 mm or more, without evidence of endoleak, migration or structural alteration of the endografts. The surgical access was by medial laparotomy in one case, flank incision in two cases and mini-laparotomy with laparoscopic assistance in the fourth case. Patients were followed with spiral CT and duplex ultrasound at discharge and at 6–12 months. Results All procedures were carried out, without complication. Two patients required intensive care unit (ICU) admission and the average post-operative hospital stay was 10 days (range 6–13). All patients are currently alive with a functioning endograft, at an average follow-up of 14.7 months. Conclusions Sacotomy, leaving the endograft in place, appears to be a feasible therapeutic option, less invasive than conversion to open repair. This technique merits further study.

Living Donor Nephrectomy: Flank Incision Versus Anterior Vertical Mini-Incision

Currently, many centers perform laparoscopic donor nephrectomy (DN). We studied the outcome of donors and recipients following open DN using either flank incision (ODN) or mini-incision (MIDN). Data of 196 living kidney donors were recorded prospectively. In 127 cases ODN and 69 cases MIDN were performed. Demographic details of donors were comparable for both groups. The left kidney was procured in 58% for ODN and in 64% for MIDN. Multiple arteries were more frequently present when MIDN (11% vs. 28%) was performed. The mean operating time was 129 min for ODN and 133 min for MIDN. Early complications occurred in 7% following ODN and in 4% following MIDN. Late complications were observed in 21% after ODN and 1% after MIDN. The mean hospital stay was significantly longer following ODN compared with MIDN (7.5 vs. 6.4 days). The primary graft function rate was 97% in both groups. One-year graft survival was 97% after ODN and 100% after MIDN. Results following MIDN are superior to those following ODN. Even in case of multiple renal vessels MIDN can be safely applied. In comparison with laparoscopic DN advantages of MIDN may be reduced costs, shorter operating time, and comparable cosmetic results.

Surgical repair of the abdominal bulge: Correction of a complication of the flank incision for retroperitoneal surgery

m l m r n r n e n t u he flank incision, a commonly used surgical approach o the retroperitoneum, affords access to the retroperitoeal structures without violating the peritoneal cavity. he incision generally extends from the periumbilical egion to the 11 intercostal space, although variations xist. Common applications include access to the aorta r iliac vessels and to the kidney or proximal ureter. lthough this approach was first described in the 1830s y Sir Astley Cooper, it did not become widely used in ascular surgery until it was reintroduced by Rob in 963 for access to the abdominal aorta. In the current ascular surgery literature, debate continues concerning he superiority of the retroperitoneal or transperitoneal pproach to the abdominal aorta. This debate notithstanding, there is agreement that the retroperitoneal pproach to the aorta is indicated in certain clinical sitations including obesity, multiple earlier laparotomies, orseshoe kidney, and suprarenal aortic aneurysms. In ddition, this incision is one of the preferred approaches o the kidney. Because the flank incision has become more widely sed, its complications have become better recognized. hese complications include local pain, intercostal neuopathy, incisional hernia, and the entity termed abominal or flank bulge or eventration. A flank bulge is ot a hernia because there is no underlying fascial defect. nstead, the protuberance of the abdomen is caused by a axity of the abdominal musculature. This laxity is beieved to be secondary to intercostal nerve injury as the ncision extends laterally toward the intercostal space. n two published series of patients undergoing a retro-

To compare the superiority of electrocautery over the traditional scalpel for skin incisions

Background. This study was designed to assess whether electrocautery can be used for incising skin in various abdominal operations. To date, many trials have been conducted to this regard, but drew inconclusive. Methods. A prospective analysis of 60 patients was done. The age of the patients included in the trial ranged from age 15 to 60 years. The patients were randomized into two groups, namely “incision by scalpel” and “incision by electrocautery.” These populations were further subgrouped into those receiving Flank incisions, those receiving Kocher’s incisions, and those receiving Midline incisions. The parameters used to compare the two primary groups were pain (on the visual analog scale), blood loss from the incision, time taken to make the incision, incidence of postoperative wound infection, and finally the cosmetic appeal upon follow-up. Results. The results showed significantly less blood loss as well as less pain scores associated with electrocautery incisions over scalpel incisions. The electrocautery incisions also took less time to make. Although the time taken and the blood loss did not attain statistical significance in the Midline abdominal incisions, the results still favored use of electrocautery in midline as well as other incisions. Postoperatively, the rates of wound infection were comparable in both techniques (3 in scalpel and 2 in cautery incision.). The cosmetic appeal was superior in the incisions that employed use of electrocautery. Conclusions. The method of electrosurgical incision is seen to be an easily learned, safe, highly effective technique associated with lesser complications. Comparing the three incisions, less pain and less bleed was noted with use of electrocautery. Additionally, there was no incidence of postoperative hematomas, no delay in healing of wounds incised by diathermy and the aesthetic results obtained were superior with minimal scarring. The difference in the incidence of wound infections was not significant. We concluded that use of electrocautery is a suitable method of skin incision; especially when employed for Kocher’s abdominal incision and abdominal flank incisions, although its use in Midline abdominal incisions did not show significant superiority.

Retroperitoneoscopic live donor nephrectomy: Extended experience in a single center

Introduction Retroperitoneoscopic live donor nephrectomy (RPLDN) was performed because it is considered to be less invasive than open live donor-nephrectomy (OLDN) or transperitoneal laparoscopic live donor nephrectomy. Patients and methods Between July 2001 and May 2003, 118 consecutive live donor kidney grafts were procured using RPLDN or OLDN. The patients who underwent RPLDN were divided into 2 groups: an initial group 1 (n = 38) and a subsequent group 2 (n = 48).Thirty-two patients who underwent OLDN during the same period were used as controls (group 3). The patients were placed in the lateral position. Three retroperitoneoscopic ports were inserted. The kidneys were retrieved through a 5-cm flank incision just below the 11th rib in group 1. In group 2, a 5-cm Pfannenstiel incision was used to extract the kidney. Results The operative time was 307 ± 88 minutes, 245 ± 42 minutes, and 215 ± 70 minutes in groups 1, 2, and 3, respectively (group 1 vs group 2 or 3, P < .01). The mean postoperative pentazocine (painkiller) requirements were 12 mg, 4.4 mg, and 22 mg in groups 1, 2, and 3, respectively (group 2 vs group 1 or 3, P < .01). The hospital stay was 6.6 ± 1.6, 4.9 ± 0.7, and 7.0 ± 0.1 days in groups 1, 2, and 3, respectively (group 2 vs group 1 or 3, P < .01). There were no serious complication, such as massive bleeding or bowel injury. Conclusions RPLDN may be safer and less invasive than open donor nephrectomy.

Indications for the anterior extraperitoneal approach in pediatric urologic surgery: The Chicago experience

Abstract Introduction: The usefulness of the anterior extraperitoneal surgical approach is recognized for adult donor and radical nephrectomy. As this technique has not received wide pediatric examination, we report our experience with this procedure and present usage guidelines. Methods: Between 1999 and 2003, patients underwent surgery at our institution via an anterior extraperitoneal incision when there was atypical renal anatomy or planned simultaneous renal and lower ureteral surgery. Results: The anterior extraperitoneal approach was successfully used in ten patients (11 kidneys) between the ages of 2 months and 15 years. Six patients underwent pyeloplasties for ureteropelvic junction (UPJ) obstruction in kidneys with additional anatomical considerations (# cases): ptotic kidney (1), horseshoe kidney (2), crossed fused ectopia (1), redo pyeloplasty (1), and multiple renal calculi mandating nephrostolithotomy (1). Two patients had urinary undiversions and one had a nephroureterectomy for an ectopic ureter to the prostate. Another patient with end-stage renal disease and refractory hypertension underwent bilateral nephrectomies via bilateral incisions to leave the peritoneum intact for future renal transplantation. All procedures were performed without complications and the surgical exposure was excellent in all cases. The surgical exposure likely would have been restricted if a traditional flank incision had been done in these cases. Conclusions: We recommend the anterior extraperitoneal approach for pediatric renal surgery if exposure of anomalous renal anatomy would be restricted by traditional flank surgery. Also, access to both kidneys can be obtained with bilateral incisions without violating the peritoneal cavity.

Assessment of body image alteration after renal surgery using a novel three-dimensional laser scanner

Objectives To evaluate the utility of a newly developed three-dimensional (3D) body surface laser scanner and evaluate the body surface image of patients undergoing renal surgery to determine the impact of surgery on body image alterations. Methods The body surface image in the upright position was obtained using the Bodyline Scanner (Hamamatsu Photonics K.K., Hamamatsu, Japan), a 3D body surface laser scanner, in 27 patients who had undergone renal surgery. We compared the objective results of body image scanning with the subjective results of a self-administered questionnaire on perception and concern about body image alteration. Results The abdominal body surface area and volume of the operative side was significantly larger than that of the contralateral side in 18 patients undergoing renal surgery using a flank incision (median area 50.7%, P = 0.002; volume 51.2%, P <0.001). A statistically significant difference was not observed in 9 patients undergoing transperitoneal or laparoscopic surgery (median area 50.0%, P = 0.34; volume 49.9%, P = 0.40). The volume alteration measured by the 3D body surface laser scanner correlated with the patients' perception ( P = 0.01) and concern ( P = 0.03) about postoperative body image alteration as assessed by the self-administered questionnaire. Conclusions The 3D body surface scanner is promising as a tool in the medical field in that it enables a computerized body image to be constructed in the upright position that reflects patients' subjective perceptions well. Using this, we observed that the flank incision causes postoperative changes in body image perceptible to the patient and a cause for concern.

LAPAROSCOPIC VS OPEN LIVING DONOR NEPHRECTOMY EXPERIENCES FROM A PROSPECTIVE, RANDOMISED, SINGLE CENTER STUDY; FOCUSING ON DONOR SAFETY

O222* Aims: An Australian safety group has concluded (Transplantation 70: 1659-66, 2000) that the evidence-base for laparoscopic living donor nephrectomy (L-LDN) is inadequate to make recommendations regarding safety and efficacy. Very few randomised studies have been presented. Recently, growing concern about donor safety has been stated in the US (JAMA 290: 181-4, 2003), based on the deaths of 5 kidney donors shortly after surgery. The present paper emphasizes our L-LDN experiences regarding complications/safety. Methods: We have since Febr. 2001 been conducting a prospective study, with the intention to randomize 120 donors to open (∼60) versus laparoscopic (∼60) LDN. Our experience prior to the study, consisted of 34 left-sided L-LDN; whereas more than 1700 open LDN (O-LDN) had been performed, by flank incision. By March 2004, we are close to full inclusion; 118 donors have been randomised to 61 L-LDN and 57 O-LDN; all left-sided.FigureConclusions: These preliminary results from our randomised study do suggest that the convential O-LDN is a very secure procedure; superior to L-LDN with regard to donor safety. There has been an unacceptably high rate of reop. in our L-LDN series, however without significant sequelae. Our data suggest that laparoscopic donor safety may be improved by increasing experience; avoiding obese donors, and by hand-assistance. Regarding postop. pain/convalescence, L-LDN seems to be the superior method.

The Anterior Endoscopic Approach for Correction of Spinal Anomalies

Purpose: Traditionally, a thoracotomy, thoracolumbar, or flank incision has been utilized for exposure to the thoracolumbar spine for anterior release, diskectomy, and fusion (RDF) for correction of significant scoliosis or kyphosis. Following the anterior procedure, posterior fusion and instrumentation have been performed through a long posterior midline incision. Methods: This is a retrospective study of a single institution's experience with the first 50 patients undergoing thoracoscopy and retroperitoneoscopy for correction of their spinal anomalies. Results: The first 50 patients underwent 51 operations between 1995 and 1999. The patients ranged in age from 2 to 21 years (mean, 14.3 years) and 32 were female. Forty-three operations involved thoracoscopic RDF and three additional operations occurred primarily in the retroperitoneum. Each of these was followed by open posterior fusion and instrumentation except in the seven young patients with congenital hemivertebrae. In five additional operations, anterior instrumentation was added to the RDF with the operation primarily in the chest in three patients and in the retroperitoneum in two patients. The minimum followup in all patients has been three years. In the RDF group alone, all but one patient have been felt to have an excellent to good correction. Of the five instrumented patients, two developed complications. Conclusion: Thoracoscopic and retroperitoneoscopic RDF can be performed safely and efficiently. The addition of anterior endoscopic instrumentation is a more difficult procedure and requires additional experience and training.

Keeping up with the Jones's: open donor nephrectomy in the laparoscopic era

Several new approaches have been developed to perform donor nephrectomy. These include laparoscopic donor nephrectomy and open donor nephrectomy performed through small incisions, herein referred to as “mini-open donor nephrectomy”. In the past, we performed open donor nephrectomy via a standard flank incision. In October 2002, we introduced mini-open donor nephrectomy via an anterior, retroperitoneal approach. Contemporaneously, we offered the option of laparoscopic donor nephrectomy. Herein, we review our single-center experience with these three techniques. Mini-open donor nephrectomy was comparable to the laparoscopic approach for duration of narcotic requirement and donor length of stay. The laparoscopic procedure was more expensive. Both procedures demonstrated improvement over the flank approach by eliminating the risk of pneumothorax, neuropathy, and flank bulge. In addition, length of stay and narcotic requirements were higher with the flank approach. Mini-open donor nephrectomy provides a good alternative to laparoscopic surgery, offering the donor an equivalent convalescence at lower cost and potentially with reduced morbidity.

Laparoscopic live-donor nephrectomy: modifications for developing nations.

To describe modifications to laparoscopic live-donor nephrectomy (LLDN) to make it more cost-effective for developing countries; LLDN was developed as a better alternative to conventional donor nephrectomy, with advantages of an earlier return to normal activities and smaller scars, but is not popular in developing countries because of high cost of disposable items. From January 2000 to January 2002, 148 LLDNs were performed, of which two used a hand-assisted technique, 17 the standard technique, 79 a modified laparoscopically assisted cost-saving approach and 50 by the modified technique. In the latter approach the kidney was delivered through a 6-8 cm anterior subcostal flank incision. In last 50 patients we further modified the technique, clipping the hilum using endoclips and delivering the kidney by holding the lateral pararenal fat through a 5 cm iliac fossa incision. The mean age, operative duration, warm ischaemia time, blood loss, analgesic requirements, pain score and hospital stay were comparable among the various techniques used. Re-exploration was required in four patients (bleeding in two, trocar-induced bowel injury in two). Immediate complications after surgery occurred in 20% of patients. Using endoclips, the cost was considerably reduced, from $400 to $290. The iliac fossa incision was aesthetically pleasing and more acceptable to patients. These modifications are relevant in the context of a developing nation, as they provide all the benefits of LLDN at reduced cost and with better cosmetic results.

Laparoscopic-assisted renal autotransplantation

Objectives To report our experience with laparoscopic nephrectomy and autotransplantation for the management of a variety of conditions with significant loss of healthy ureteral tissue or ureteral length. Renal autotransplantation has been described as an effective method for addressing this problem, avoiding the need for nephrectomy or complex ureteral replacement. In an effort to decrease the morbidity associated with traditional autotransplantation we elected to perform laparoscopic procurement of the kidney. Methods Four patients underwent laparoscopic nephrectomy using a transperitoneal four-port technique and subsequent autotransplantation into the iliac fossa for the treatment of proximal ureteral avulsion (2 patients), ureteral malignancy, and ureteral stricture. All patients had less than 5 cm of viable ureter. Results All procedures were performed without intraoperative complications. All renal scans on postoperative day 1 demonstrated good perfusion. None of the patients had a postoperative rise in serum creatinine. On postoperative day 1, the mean creatinine value was 0.95 mg/dL. Three patients had an uneventful postoperative course. One patient, however, had loss of the graft because of renal vein thrombosis on postoperative day 7. She was later found to have an undiagnosed thrombophilic disorder (decreased levels of antithrombin III) and to have a recent history of oral contraceptive use. Conclusions Laparoscopic nephrectomy with renal autotransplantation is a feasible minimally invasive alternative to treat patients who have significant ureteral loss. This approach avoids the need for an upper abdominal or flank incision, resulting in decreased morbidity. The initial follow-up studies indicated stable renal function. Additional long-term observation is currently under way.

Donor nephrectomy in the era of hand-assisted laparoscopic urologic surgery.

Living-donor nephrectomy has traditionally been performed through a flank incision with or without rib resection or by an anterior extraperitoneal incision, both of which reduce the willingness of potential donors to undergo the procedure. The first successful human laparoscopic donor nephrectomy was reported in 1995. In order to reduce warm ischemia and operative time and to make the operation safer and easier, some laparoscopic surgeons have used hand assistance. The authors describe their technique for this operation and review the results.

Permanent flank bulge is a consequence of flank incision for radical nephrectomy in one half of patients

The objective of the study was to determine the incidence and predictors of post operative pain and flank bulging in patients undergoing nephrectomy for a renal tumor through a flank or thoracoabdominal incision. Only one previous retrospective study (1974) has directly addressed this issue in urologic patients. This reported a 3% incidence of flank bulging. This was at variance with our own experience. To determine the incidence of pain and post-operative flank bulge after flank or thoraco-abdominal incision, a cross sectional survey among in 70 patients, who had a nephrectomy for a renal tumor between 1996 and 2000, was assessed by telephone interview. Four surgeons contributed patients to the study. Thirty-four of seventy (49%) patients complained of a flank bulge persisting more than 1 yr after surgery. Durable flank pain was experienced by 24%. This was severe in 3% of patients. Median pain magnitude was 5/10. There was no difference in bulge incidence between surgeons ( P = 0.49). Flank bulging occurred more frequently in left sided nephrectomy ( P = 0.054) than right. Other parameters including gender, age, and tumor size had no correlation with the rate of either complication. In all patients who described a flank bulge, the deformity was durable; there were no cases of spontaneous resolution. Patients described a significant impact on QOL, particularly in those under 60 yrs. The overall rate of postoperative flank bulging is considerably higher than has been previously reported. This deformity affects quality of life. The observation that almost 50% of patients experience a flank bulge following a flank incision supports the shift towards laparoscopic nephrectomy, and should be incorporated into decision making regarding the optimal surgical approach. This may be particularly relevant in the choice between open partial nephrectomy and laparoscopic radical nephrectomy in a patient with a normal contralateral kidney.

Endoscopic resection of lower ureter in upper urinary tract tumors.

To evaluate the efficacy and safety of endoscopic resection of lower ureter in upper urinary tract tumor cases. Five patients with transitional cell carcinoma (TCC) of the upper urinary tract were enrolled in this study. Nephrectomy was carried out through a flank incision and distal ureter with a cuff of bladder, which was removed using endoscopic approach. Complications and recurrence rate were evaluated. A total of 5 patients with upper urinary tract tumor underwent the endoscopic resection of lower ureter. All the patients had grade I transitional cell tumor. Two patients had suffered from bladder TCC treated previously. During the follow-up two cases developed bladder tumor: one, 18 months and another, one year postoperatively, both in the base of bladder, which was managed successfully by transurethral resection (TUR). Endoscopic resection of lower ureter in selected patients with upper urinary tract tumors can lead to lower morbidity, shorter operation time, and higher patient's satisfaction. Despite the minority of cases in this study, it seems that this method is applicable in selected cases.

206POSTNATAL MANAGEMENT OF CHRYPTORCHID BANTENG CALVES CLONED BY NUCLEAR TRANSFER UTILIZING FROZEN FIBROBLAST CULTURES AND ENUCLEATED COW OVA

A multi-institutional collaboration was developed to evaluate the potential for conservation management of genetic variation in captive banteng calves via nuclear transfer cloning of a deceased genetically valuable individual. Fibroblast cultures frozen in 1978 were fused with enucleated cow ova and resulting embryos were transferred to domestic beef cattle for gestation. Two banteng (Bos javanicus) calves produced by heterologous nuclear transfer were delivered by standing Cesarean section on April 1 and 3, 2003. Birth weights for the two calves were 23.13 and 38.64kg, respectively. The larger calf failed to gain strength and died on April 8. The surviving calf was transferred from Sioux Center, IA, to the San Diego Wild Animal Park in Escondido, CA on April 18, 2003. The calf was offered a goat’s milk-based formula containing 21.9kJ metabolizable energy (ME) and 22% total solids. The total solids fraction consisted of 26.3% crude protein, 29.8% crude fat, 33.5% total carbohydrate. Intake and growth rate for this calf was compared to other hand-reared bovid calves produced by normal mating. Average daily gain from birth to 16 weeks of age was 767g day−1. A routine neonatal physical examination revealed that the surviving calf was bilaterally cryptorchid. The large calf that did not survive was noted to have one abdominally retained testicle, whereas the other testicle was scrotal. Ultrasound examination of the healthy banteng calf confirmed abdominal localization of the retained testicles. Both testes were located in the abdominal cavity about 4–6cm from the caudal pole of the kidneys. Therapeutic intervention was considered because of the genetic value of the calf and because the cell donor exhibited normal scrotal testicles. In July, 2003, orchipexy was conducted on this calf. The left testis was exteriorized through a small abdominal flank incision. After freeing it from tissue holding it in place, it was relocated through a subcutaneous tunnel to a pouch created just in front of the scrotum. The attachments to the testis were not long enough to allow the testis to be placed fully in the scrotum. At a follow-up examination conducted four weeks after the surgery, the left testicle was palpable in the subcutaneous pouch just cranial to the scrotum. Under ultrasound examination, the left testicle was easily identified less than 1 cm deep with echogenic texture of a testis. Color flow Doppler ultrasound analysis demonstrated pulsatile flow in the center of the testis synchronous with the heart beat. These findings indicate testicular viability and blood supply.

Laparoscopic live donor nephrectomy: the anaesthesiologist's perspective

Laparoscopic live donor nephrectomy: the anaesthesiologist's perspective

Mini incision live donor nephrectomy: an optimal approach for the developing countries.

Laparoscopic donor nephrectomy (LD) is rapidly gaining popularity, however, this may not be affordable by donors in many developing countries because of its high cost. We describe our mini flank incision (MD) donor nephrectomy technique and its outcome. A 7-10-cm subcostal rib sparing transverse incision was given 2 cm lateral to the tip of the 12th rib, towards the lateral border of rectus muscle. All dissections were performed with help of long retractors and instruments, vessels were transfixed and cut. In last 45 cases, vessels were clipped with Liga or Weck clips. Donors and recipients outcome was analysed. From January 2000 to December 2002 a total of 148 patients underwent donor nephrectomy by mini incision technique. Mean patient age was 44.8 +/- 7.3 yr (range 20-70 yr). Nephrectomies were performed in 115 patients on the left side and in 33 cases on the right side. The mean incision length was 9.1 +/- 1.8 cm (range 7-10 cm). Mean operative time was 105 +/- 10.5 min (70-130 min). Mean analgesic (Tramadol) requirement was 205 +/- 52 mg; postoperative hospital stay was 2.2 +/- 0.5 d. Twelve per cent patients developed fever and 4% had superficial wound infection in postoperative period. Three patients required blood transfusion. Mean convalescence period was 22 +/- 2.8 d. Extrapleural, extraperitoneal, subcostal mini incisions live donor nephrectomy is a relatively safe procedure with low morbidity. This technique has a shorter hospital stay, early convalescence and better cosmesis. It is cost-effective and is an ideal substitute for the developing country.

Flank incision for adenocarcinoma of the splenic flexure in the obese.

Journal of Surgical OncologyVolume 84, Issue 3 p. 178-179 How I Do It Flank incision for adenocarcinoma of the splenic flexure in the obese Mahmoud N. Kulaylat MD, FACS, Corresponding Author Mahmoud N. Kulaylat MD, FACS [email protected] [email protected] State University of New York at Buffalo, Department of Surgery, Kaleida Health, Buffalo, New Yorkc/o Ms. JoAnn Ulatowski, Department of Surgery, Kaleida Health, Millard Fillmore Hospital, 3 Gates Circle, Buffalo, NY 14209. Fax: 716-887-4220.Search for more papers by this authorConstantine P. Karakousis MD, PhD, FACS, Constantine P. Karakousis MD, PhD, FACS State University of New York at Buffalo, Department of Surgery, Kaleida Health, Buffalo, New YorkSearch for more papers by this author Mahmoud N. Kulaylat MD, FACS, Corresponding Author Mahmoud N. Kulaylat MD, FACS [email protected] [email protected] State University of New York at Buffalo, Department of Surgery, Kaleida Health, Buffalo, New Yorkc/o Ms. JoAnn Ulatowski, Department of Surgery, Kaleida Health, Millard Fillmore Hospital, 3 Gates Circle, Buffalo, NY 14209. Fax: 716-887-4220.Search for more papers by this authorConstantine P. Karakousis MD, PhD, FACS, Constantine P. Karakousis MD, PhD, FACS State University of New York at Buffalo, Department of Surgery, Kaleida Health, Buffalo, New YorkSearch for more papers by this author First published: 29 October 2003 https://doi.org/10.1002/jso.10306AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume84, Issue3November 2003Pages 178-179 RelatedInformation

The Use of Transversely Tubularized Bowel Segment for Segmental Ureteral Replacement

The aim of the present study was to evaluate the results of the use of a new technique, i.e. transversely tubularized bowel segment (TTBS) for segmental ureteral replacement in pigs. Eight pigs had segmental left ureteral replacement with the TTBS technique, via midline incision in 5 and flank incision in 3. The right ureters were left untouched and used as controls. The pigs were evaluated by excretory urography approximately 3 months after surgery and then sacrificed thereafter, harvesting the kidneys, ureters, and the bladders en bloc for macroscopic and histologic examination. Three pigs died in the early postoperative period. The remaining 5 pigs were followed for 82–112 days. Postoperative intravenous urograms revealed moderate ureterohydronephrosis in 2, mild ureteral dilation in 1, and normal upper tracts in 2. The 2 pigs with moderate ureterohydronephrosis had had midline incisions, and examination after having sacrificed these pigs revealed many intestinal adhesions to the anastomotic region. Easy catheterization of each left ureter through ileal ureteral segment and histologic examination thereafter demonstrated that all ileal ureteral segments including anastomotic sites were patent. Adjacent to the junctional area, metaplastic transitional epithelium covered atrophic villi and in some regions crypts as well. Ureteral replacement by the TTBS technique seems to be a safe and effective surgical treatment option in segmental ureteral defects in short term. However, long-term follow-up studies are needed.