Laparoscopic Boari Flap Research Articles

Surgical management in retroperitoneal fibrosis: beyond ureterolysis

BackgroundRetroperitoneal fibrosis can be associated with bilateral dense and extensive periureteral adhesions. When ureterolysis could not be successfully performed due to disease extent and severity, elaborate ureteral reconstructive procedures will be required.Case presentationA young male with retroperitoneal fibrosis presented with bilateral hydroureteronephrosis. The ureteral involvement was extensive and adhesions were dense. He was managed by laparoscopic boari flap ureteroneocystostomy on one renal unit and laparoscopic nephrectomy with renal autotransplantation on the other renal unit.ConclusionsUreterolysis is not feasible in all cases of retroperitoneal fibrosis. Extensive bilateral ureteral reconstruction without using intestinal segments is feasible. Minimally invasive surgical reconstructive procedures can be successfully employed in such scenarios also.

Laparoscopic Boari flap formation in advanced ovarian carcinoma

To demonstrate laparoscopic ureteric reconstruction with formation of a Boari flap. We present video footage of a laparoscopic Boari flap formation in a patient with previous extensive primary debulking surgery...

Laparoscopic Ureteral Reimplantation for the Management of Long-segment Ureteral Defect in Gynecologic Surgeries

To demonstrate techniques of laparoscopic ureteral reconstruction for long-segment ureteral defects in gynecologic surgeries. Step-by-step demonstration of a laparoscopic ureteral reimplantation using the Boari flap and ileal interposition. Gynecologic diseases often involve the ureter; hence, knowledge of ureteral reconstruction techniques is imperative in gynecologic surgeries. The important aspect of ureteral reconstruction is to ensure tension-free anastomosis; therefore, various methods are required depending on the length of the ureteral defect [1]. The Boari flap and ileal interposition are preferred for repairing 8-cm to 12-cm and >12-cm ureteral defects, respectively. These methods have traditionally required large incisions [2,3]. Laparoscopic ureteral reimplantation using the Boari flap and ileal interposition has been reported to be as safe as the open technique and superior in terms of postoperative recovery in urologic surgeries [3,4]; however, to the best of our knowledge, it has not been reported in the field of gynecology. To our knowledge, this is the first report to demonstrate the techniques of laparoscopic Boari flap and ileal ureter replacement in gynecologic surgeries. The technique was approved by our institutional review board. The first case involved an intra-abdominal desmoid tumor, whereas the second case involved recurrent endometrial cancer. In both cases, long-segment ureteral resection was required to achieve complete tumor clearance. Laparoscopic ureteral reimplantation was performed successfully, without any complications, using the Boari flap in the first case and ileal interposition in the second. Laparoscopic ureteral reimplantation is technically feasible for the management of long-segment ureteral defects.

Laparoscopic Boari Flap for Inadvertent Ureteral Injury During Die Resection

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

Laparoscopic Ureteral Reconstruction- Three Steps for Any Ureteral Defect

Video Objective To demonstrate methods to compensate for large ureteral defects after extensive resection of ureteral endometriosis. I will present 3 methods, the psoas hitch, the Boari flap and ileal interposition. Setting Urban general hospital in Japan. Interventions These patients suffered from ureteral stenosis, hydronephrosis and hydroureter. We performed laparoscopic extensive resection of DIE and the resection of the involved ureter. As a result of the resection, we needed reconstruction of the urinary tract. The type of reconstruction depends on the size of the defect. We need intact and tension-free anastomosis of the ureter and the bladder. If the involved segment is small, we perform simple reimplantation of the ureter to the bladder. However, if the defect is larger, we need to perform a psoas hitch and sometimes a Boari flap in accordance with how much length of the ureter needs to be compensated for. In rare cases where there is a great deal of loss of ureteral length, we interpose a graft of the ileum. The harvest defect of the ileum in reconstructed with functional end-to-end anastomosis. Conclusion The laparoscopic psoas hitch, Boari flap and ilieal ureter are reconstructive techniques that allow for more extensive resection of endometriosis by minimally invasive surgery. These techniques provide tension-free adaptation after extensive resection of the ureter.

Robotic-assisted laparoscopic Boari flap ureteroplasty for ureteral strictures after kidney transplantation

Objective To evaluate the clinical efficacy and safety of robotic-assisted laparoscopic Boari flap ureteroplasty for ureteral strictures after kidney transplantation. Methods The clinical data of 2 patients with ureteral stricture after kidney transplantation in our department from May 2017 to September 2017 were retrospectively analyzed. All 2 cases were male. Case 1 was 73 years old and the transplanted kidney was located in the left iliac fossa. The patient was hospitalized due to still recurrent fever with long-term retention of nephrostomy tube because of hydronephrosis with repeated urinary tract infection after calculi surgery. Case 2 was 62 years old and the transplanted kidney was located in the right iliac fossa. The patient was hospitalized due to hydronephrosis and ureteral calculi after calculi surgery. All 2 cases were treated by robotic-assisted laparoscopic Boari flap ureteroplasty. The operative and postoperative complications were recorded and the postoperative examination data were collected. Results The operation time of the 2 cases were 165min and 189min, and the bleeding amount were 50ml and 100ml respectively. No urinary leakage, renal colic, high fever and other complications occurred. In case 1, nephrostomy tube was removed 8d after operation. The urinary catheters were removed 14d after operation in the 2 cases. The postoperative hospital day was 9d and 6d respectively. CT examination was performed 3 months after surgery. Compared with preoperative, case 1 had no significant change in hydronephrosis and the hydronephrosis of case 2 obviously relieved. In case 1, double J tube was removed in 3 months after operation. In case 2, double J tube was replaced in 3 months after operation and was removed after 3 months. 2 patients were followed up to 18 months and 14 months after operation, respectively. No hydronephrosis aggravated. Conclusions Robotic-assisted laparoscopic Boari flap ureteroplasty is a safe and effective treatment for ureteral strictures after kidney transplantation. It has the advantages of small trauma, quick recovery, exact effect and few complications. Key words: Kidney transplantation; Ureteral stricture; Robot; Laparoscopy; Boari flap plasty

Laparoscopic ureteral reimplantation with Boari flap for the management of long- segment ureteral defect: A case series with review of the literature.

The incidence of ureteral stricture is showing a rising trend due to increased use of laparoscopic and upper urinary tract endoscopic procedures. Boari flap is the preferred method of repairing long- segment ureteral defects of 8-12 cm. The procedure has undergone change from classical open (transperitoneal and retroperitoneal) method to laparoscopic surgery and recently robotic surgery. Laparoscopic approach is cosmetically appealing, less morbid and with shorter hospital stay. In this case series, we report our experience of performing laparoscopic ureteral reimplantation with Boari flap in 3 patients. This prospective study was conducted between January 2011 December 2014. The patients with a long- segment ureteral defect who had undergone laparoscopic Boari flap reconstruction were included in the study. Outcome of laparoscopic ureteral reimplantation with Boari flap for the manangement of long segment ureteral defect was evaluated. The procedure was performed on 3 patients, and male to female ratio was 1:2. One patient had bilateral and other two patient had left ureteral stricture. The mean length of ureteral stricture was 8.6 cm (range 8.2-9.2 cm). The mean operative time was 206 min (190 to 220 min). The average estimated blood loss was 100 mL (range 90-110 mL) and mean hospital stay was 6 days (range 5 to 7 days). The mean follow up was 19 months (range 17-22 months). None of the patients experienced any complication related to the procedure in perioperative period. Laparoscopic ureteral reimplantation with Boari flap is safe, feasible and has excellent long term results. However, the procedure is technically challenging, requires extensive experience of intracorporeal suturing.

Laparoscopic Ureteroneocystostomy for Iatrogenic Ureteral Insult—Early and Delayed Repairs

Introduction: Ureteral rehabilitation after iatrogenic ureteral insult poses dual challenges—satisfactory restoration of ureteral continuity and limiting the procedural morbidity. In cases refractory to endourologic approach, the laparoscopic approach may be attempted in view of its favorable morbidity profile. The procedural performance may be considerably affected by the time interval between the primary insult and the restorative procedure.1 We present a video demonstration of this approach in different scenarios. Methods: All patients are evaluated in detail. Imaging included ultrasonography, magnetic resonance urogram or computed tomography urogram, cystoscopy, and retrograde urogram. Patients refractory to endourologic approach with a salvageable renal unit were planned for laparoscopic approach. All procedures were attempted through transperitoneal access utilizing four ports. After familiarizing with the pelvic anatomy, the lower ureteral course was identified. Dissection was continued till the pathological segment. Periureteral adventitia was meticulously preserved during ureteral handling, and thermal energy was utilized selectively. Ureter was dismembered proximal to the pathological segment. The ureter edge was refreshened and spatulated to ensure wide anastomosis. The vesical unit was then mobilized to ensure tension-free approximation. Additional psoas hitch was employed when tension was apprehended during ureterovesical approximation and Boari flap in long-segment defects. Ureteroneocystostomy was conducted with 3-0 polyglactin. Ureteral stent was inserted intracorporeal. Postoperative course was recorded. Ureteral stents were removed at 6 weeks postprocedure. Subsequent follow-ups were scheduled 3 monthly. Imaging was repeated at 6 months postprocedure. Resolution of hydronephrosis and a satisfactory drainage pattern were appraised as a successful outcome. Results and Discussion: Forty-five laparoscopic ureteroneocystostomies were performed between June 2006 and December 2011. Mean±SD age was 37.4±3.5 years. Two were men and 43 women. Etiologies included gynecological surgeries (41 cases), colorectal surgeries (2 cases), and urological surgeries (2 cases). Injuries involved right side in 35 cases, left side in 8 cases, and bilateral in 1 case. All procedures were completed successfully by a laparoscopic approach. Twenty-four patients underwent laparoscopic ureteroneocystomy with psoas hitch, and 19 patients underwent laparoscopic ureteroneocystomy and 2 patients laparoscopic Boari flap. Twenty-five procedures were undertaken within 7 days of the primary event, and 20 procedures were performed after 2 weeks of the primary event. The mean±SD operation duration was 155±10.2 minutes. The mean±SD blood loss was 120±22.5 mL. The operation duration in early and delayed repairs differed significantly (187.05±12.8 minutes, vs. 113.27±17.7 minutes, p = 0.00). No remarkable intraoperative complications were encountered. The mean±SD hospital stay was 3.5±1.2 days. Forty-three patients completed 6-month follow-up and revealed satisfactory outcome. No patients required any additional intervention. Laparoscopic ureteroneocystostomy after iatrogenic ureteral insult is feasible in different scenarios and offers durable outcome with limited morbidity. Diligent handling of the ureter and anastomosis without tension are key aspects of this exercise. The operator should be sufficiently versed with laparoscopic anatomy and intracorporeal suturing exercises. No competing financial interests exist. Runtime of video: 7 mins 35 secs

Laparoscopic Boari Flap Ureteroneocystostomy in Solitary and Bilaterally Functioning Renal Units: Our Experience

Abstract Introduction: Long segment lower ureteral strictures may be reconstructed through creation of Boari flap ureteroneocystostomy. Although conventionally performed through incisional approach...

Laparoscopic Boari Flap- Psoas Hitch Method for Extensive Ureteral Endometriosis

Ureteral endometriosis is a rare yet important entity that can even lead to silent renal failure. Sometimes extensive resection and complex reconstruction of ureter is required to compensate for large ureteral defects. To make this intrinsically invasive procedure more patient friendly we introduced a laparoscopic Boari flap with psoas hitch method. This method is an effective option for bridging large lower ureteral defects when tension would still exist after anasotmosis. We present both extravesical and transvesical methods.

V1540 THE LAPAROSCOPIC BOARI FLAP

You have accessJournal of UrologyReconstruction1 Apr 2010V1540 THE LAPAROSCOPIC BOARI FLAP Mahmoud Shalaby, Ahmed Shoma, Fathy Elanany, Nashwa Barakat, and Magdy El-Akkad Mahmoud ShalabyMahmoud Shalaby Assiut, Egypt More articles by this author , Ahmed ShomaAhmed Shoma Mansoura, Egypt More articles by this author , Fathy ElananyFathy Elanany Assiut, Egypt More articles by this author , Nashwa BarakatNashwa Barakat Mansoura, Egypt More articles by this author , and Magdy El-AkkadMagdy El-Akkad Assiut, Egypt More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1292AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laparoscopic ureteroneocystostomy in humans was first described by Ehrlich and colleagues in 1994 for management of vesicoureteral reflux. Loss of distal ureteral segment may interfere with tension-free ureteroneocystostomy. In this particular situation, the Boari flap is a solution, which stood the test of time. Objective: to test the feasibility of laparoscopic Boari flap ureteroneocystostomy in an experimental setting before clinical application. METHODS This video describes the technique of laparoscopic Boari flap to restore the patency of an experimentally ligated ureter of a female Mongorel dog. Four dogs were subjected to this experiment. Partial obstruction of the ureter was performed three weeks before the procedure. Follow up IVU and retrograde cystogram were performed three weeks after removal of stents. RESULTS Operative time for the laparoscopic Boari flap procedures ranged from 230 to 360 minutes (mean 271 minutes) again with remarkable improvement after the first procedure (360 minutes for the first, 240 minutes for the second, 255 minutes for the third and 230 minutes for the fourth procedure). All dogs experienced smooth postoperative course. Intravenous urography was performed three weeks after removal of stents and all the four renal units showed normal secretion of the dye, normal size and patent, normal ureters. CONCLUSIONS Laparoscopic Boari flap is a feasible technique, which requires orientation with the principals of reconstructive laparoscopic surgery. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e594 Peer Review Report Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mahmoud Shalaby Assiut, Egypt More articles by this author Ahmed Shoma Mansoura, Egypt More articles by this author Fathy Elanany Assiut, Egypt More articles by this author Nashwa Barakat Mansoura, Egypt More articles by this author Magdy El-Akkad Assiut, Egypt More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

V1539 ROBOTIC-ASSISTED LAPAROSCOPIC BOARI FLAP RECONSTRUCTION FOR UNILATERAL URETERAL STRICTURE

You have accessJournal of UrologyReconstruction1 Apr 2010V1539 ROBOTIC-ASSISTED LAPAROSCOPIC BOARI FLAP RECONSTRUCTION FOR UNILATERAL URETERAL STRICTURE Jonah Marshall, Dana Schie, Hani Rashid, and Guan Wu Jonah MarshallJonah Marshall More articles by this author , Dana SchieDana Schie More articles by this author , Hani RashidHani Rashid More articles by this author , and Guan WuGuan Wu More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1291AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Boari flap is frequently used for repair of long distal/mid ureteral strictures. In this video, we show a complicated case of unilateral distal/mid ureteral strictures managed with Boari flap using a robotic-assisted laparoscopic approach. METHODS The patient is a 37-year-old female who developed a right mid ureteral stricture after aorta-to-femoral bypass surgery. She subsequently underwent an open right ureteroureterostomy. However, the primary repair failed leading to frequent right flank pain, UTIs, sepsis and nephrostomy tube placement. She was transferred to our medical center. After thorough evaluation, the patient elected to have Boari flap reconstruction. The patient was placed supine with a slight Trendelenburg position. A total of 6 ports were placed in a fan distribution in the patient's upper abdomen. Extensive lysis of adhesions was required. Right ureteral lysis was performed and the bladder mobilized. A Boari flap was created and tubularized over a 12-French red rubber catheter and anastomosed to the mid ureter. A 7-French double J ureteral stent was placed. The entire procedure was done robotically with the da Vinci S system RESULTS Operative time was approximately 4 1/2 hours. Estimated blood loss was 250 ml. Postoperative course was uneventful and the length of hospital stay was 3 days. The Foley catheter was removed on POD# 15 and the ureteral stent was removed 5 weeks after surgery. At her 12-month followup, CT urogram with delayed images showed no hydronephrosis or obstruction and her kidney function remained normal. CONCLUSIONS A robotic-assisted laparoscopic Boari flap reconstruction for unilateral distal/mid ureteral strictures is a feasible alternative to open surgery. The robotic surgical system provides us a platform to perform complex reconstruction of the urinary tract laparoscopically. Rochester, NY© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e593-e594 Peer Review Report Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jonah Marshall More articles by this author Dana Schie More articles by this author Hani Rashid More articles by this author Guan Wu More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Laparoscopic Ureteral Reimplantation: A Single Center Experience and Literature Review

Laparoscopic Boari flap, psoas hitch, and direct ureteral reimplantation have all been described in the management of benign distal ureteral strictures. A retrospective review of a single center experience of laparoscopic reconstructive surgery for benign distal ureteral strictures was undertaken. The results of this initial series were compared with the published literature. To date, six patients with benign distal ureteral strictures have undergone laparoscopic reconstructive surgery at our center. Stricture etiology was stone disease in two patients, postvaginal hysterectomy in one patient, and unknown in the remaining two. In all cases, the operative procedure was undertaken with five-port transperitoneal access. Depending on healthy ureteral length, a decision for direct reimplantation was made in two patients, and Boari flap reconstruction was undertaken in the remaining three patients. Mean operative time was 322 minutes (range 240-360 min), which is longer than in the published literature, reflecting our initial learning curve in reconstructive laparoscopy. The mean drop in hemoglobin, however, was only 0.5 g/dL, which is comparable to that in other series. Further, there were no complications, and patients were discharged at a mean of 6.6 days postoperatively (range 5-9 days). All patients had satisfactory follow-up intravenous urograms with a mean follow-up period of 4 months. Laparoscopic reconstructive surgery for managing benign distal ureteral strictures is both safe and effective. Although open surgery currently remains the gold standard for these patients, all operative steps can be replicated laparoscopically, and this may become the future standard treatment.

Laparoscopic Boari Flap Repair: Report of 3 Cases

Boari flap reimplantation is one of the options for ureteric reimplantation when the diseased ureteric segment is long. Open Boari flap reimplantation is well established. In this paper, we describe laparoscopic Boari flap reimplantation in 3 patients. Since May 2004, 3 patients had a successful laparoscopic Boari flap ureteric reimplantation. Preoperative intravenous urogram and retrograde pyelogram confirmed the length and site of the obstruction. The first patient was a 16-year-old boy with primary obstructive megaureter, with the adynamic segment extending from just below the sacro iliac joint. The second was a middle-aged diabetic lady with a long lower ureteric stricture. The third was a ureteric injury that occurred following a laparoscopic ovarian cystectomy. The mean operative time was around 320 minutes. There were no intra- or postoperative complications. All the patients recovered well and are being followed up clinically and radiologically. Laparoscopic Boari flap reimplantation is a challenging procedure. With increasing technical skill and confidence, one can attempt the procedure with the obvious advantage to the patient.

Technical Modifications to Laparoscopic Boari Flap

To describe technical modifications to the laparoscopic Boari flap ureteroneocystostomy procedure. Removal of ureteral stents with conversion to percutaneous nephrostomy drainage before surgery allowed for optimization of tissue quality and visualization during operative repair. Adherence to specific dimensional ratios during flap excision consistently provided for adequate tissue for successful Boari flap construction. A mucosal modification to the Boari flap allowed for an increase in the circumference of the anastomosis and provided an additional means to fortify the suture line and promote healing. Raised mucosal flaps on the Boari flap facilitated construction of a nonrefluxing anastomosis. Finally, a 2-mm needlescopic port placed at the level of the anastomosis facilitated simplified intracorporeal double-J ureteral placement. Laparoscopic Boari flap ureteroneocystostomy is an effective treatment of distal ureteral stricture disease. The technical modifications describe in this report aim to contribute to increased success rates in patients who undergo this procedure.

1063: Laparoscopic Boari Flap Combined with Psoas-Hitch Technique for Ureteral Obstruction: A Comparison of Laparoscopic and Open Surgical Techniques

1063: Laparoscopic Boari Flap Combined with Psoas-Hitch Technique for Ureteral Obstruction: A Comparison of Laparoscopic and Open Surgical Techniques

Laparoscopic ureteral reimplantation: A simplified dome advancement technique

Laparoscopic Boari flap reimplantation has been used to treat long distal ureteral strictures. This technique requires extensive bladder mobilization and complex intracorporeal suturing. This Video demonstrates a novel laparoscopic bladder dome advancement approach for ureteral reimplantation. This technique obviates the need for bladder pedicle dissection and simplifies the required suturing.

EARLY EXPERIENCE WITH THE LAPAROSCOPIC BOARI FLAP AT A SINGLE INSTITUTION

We present our initial experience with the laparoscopic Boari flap for long ureteral strictures. Nine patients underwent a laparoscopic Boari flap procedure at our institution. Eight patients had 4 to 7 cm distal ureteral strictures on excretory urogram and retrograde pyelogram, and 1 had transitional cell carcinoma in the distal right ureter. We analyzed our intraoperative parameters with regard to operative time and intraoperative complications. The operative results assessed were hospital stay, renal function, symptomatic improvement and radiological studies. The patient with ureteral transitional cell carcinoma was excluded from analysis because ureteral stricture etiology differed from that in the other 8. Mean operative time was 156.6 minutes. Mean estimated blood loss was 124 cc. There were no intraoperative complications. Mean hospital stay was 3 days. At a mean followup of 17.6 months all patients were symptom-free and had an unobstructed ureterovesical anastomosis on followup excretory urogram. One surgical postoperative complication resolved laparoscopically. The laparoscopic Boari flap is a feasible alternative surgical technique in patients with long distal ureteral strictures. Larger series with longer followup are needed to validate these results vs the standard open technique.

Laparoscopic treatment of retroperitoneal fibrosis.

Retroperitoneal fibrosis (RPF) is an uncommon cause of ureteral obstruction. Surgical treatment is required in most cases. Open ureterolysis, although effective, is associated with significant morbidity and mortality rates. We present data on a series of 13 patients undergoing laparoscopic ureterolysis for RPF. Between December 1994 and October 2000, 13 patients with RPF underwent laparoscopic ureterolysis at our institution. Operative time, complications, estimated intraoperative blood loss, time to oral intake, amount of parenteral analgesics used, and length of hospital stay were reviewed. Postoperative pyelography or diuretic urography was performed to assess ureteral patency. Laparoscopic ureterolysis was successful in 11 patients (85%); two conversions to open surgery were needed (15%). One patient required a laparoscopic Boari flap on one side because of intense fibrosis. Four postoperative complications (30%) were managed with conservative measures. At a mean follow-up of 30 months, intravenous urography or renal scan showed relief of obstruction in 92% of the patients. Laparoscopic ureterolysis is an option to treat RPF. It is not free of complications and failures, and its precise role in the treatment of RPF still needs to be judged with longer follow-up and larger number of patients.

LAPAROSCOPIC BLADDER FLAP URETERAL REIMPLANTATION: SURVIVAL PORCINE STUDY

The bladder or Boari flap is a useful technique for ureteroneocystostomy when the distal ureter is too short to reach the bladder without undue tension. We report our experience with laparoscopic Boari flap ureteroneocystostomy in the chronic porcine model. Six female farm pigs underwent unilateral laparoscopic Boari bladder flap ureteroneocystostomy. Refluxing direct ureteral reimplantation was performed in the initial 3 animals. In the next 3 animals a submucosal tunnel was formed to achieve nonrefluxing ureteroneocystostomy into the Boari flap. The animals were sacrificed 6 weeks after surgery. At sacrifice ascending cystography, ipsilateral antegrade pyelography and autopsy examination of the ureteroneocystostomy site was performed. No intraoperative or postoperative complications were noted. Average operative time was 140 minutes. Postoperatively serum creatinine and hemoglobin were normal in all pigs. All 3 animals with direct ureteroneocystostomy into the Boari flap had free reflux into the kidney and all 3 with a submucosal tunnel reimplant had no reflux on ascending cystography and free drainage on antegrade pyelography. Autopsy confirmed a patent anastomotic site in all 6 cases. Laparoscopic ureteroneocystostomy using the Boari bladder flap technique is feasible. Our survival porcine model confirms the successful application of the refluxing and nonrefluxing technique of ureteral reimplantation. Clinical application of the technique has the potential to decrease patient morbidity associated with traditional open surgery.