Case Report: Laparoscopic Boari Flap

Abstract

A Boari flap may be required to bridge long defects of the middle and lower ureter to the bladder. Laparoscopic construction of a Boari flap was performed in a patient with a ureteral stricture secondary to iatrogenic injury. The salient steps performed were spatulation of the transected ureteral end, fashioning of a Boari flap from the bladder, end-to-side anastomosis of the ureter to the flap, placement of a stent with the aid of a suction cannula, and closure of the flap over the stent. A Boari flap can be accomplished laparoscopically with minimal morbidity.

Robotic Versus Open Distal Ureteral Reconstruction and Reimplantation for Benign Stricture Disease

“…Case reports have since been described for this technique without a large single surgeon experience identified. 14,15 Most reports of laparoscopic distal ureteral reconstruction highlight the challenging nature of the procedure, particularly intracorporeal suturing of the distal ureter. While feasibility has been clearly demonstrated, significant experience with laparoscopy and excellent suturing skills are needed, which has limited its widespread use.…”

Laparoscopic Boari Flap Repair: Report of 3 Cases

“…5 The laparoscopic approach for this problem has been found to be difficult, as it needs excellent intracorporeal suturing skills and is technically demanding. 6,7,8,9 One can get the ureteral substitution to a length of 6-8 cm as in open surgical procedures (case 1). In case 3, where the previous surgery was laparoscopic, it was advantageous to have the second procedure also done laparoscopically.…”

Laparoscopic Boari flap for repair of long-segment ureteral avulsion or ureteral stricture: our experience with seventeen cases

“…Fugita OE et al (5)performed the first successful laparoscopic Boari flap in three patients with long-segment ureteral stricture in 2001 and confirmed that the procedure was effective and feasible.Ding G et al (20)retrospectively reviewed 35 patients with complex distal ureteral stricture.compared to open Boari flap-psoas hitch,laparoscopic surgery had advantages being a minimal invasive surgery with less estimated blood loss and fewer surgical complications.We summarize some of the teams that performed Boari flap in the laparoscopic approach,as shown in Table 3 (9,(21)(22)(23)(24)(25)(26)(27).In our study,perioperative outcomes were similar to them.During long-term follow-up,one patient developed ureteral stricture and severe hydronephrosis one year after surgery,and hydronephrosis was reduced after placement of 2 double J-tubes,and one patient had recurrent urinary tract infection,while the remaining fifteen cases did not show any abnormalities.Damage to the blood supply to the bladder flap during surgery,operator's unskilled suturing technique,the patient's own nutritional status,and poor control of diabetes mellitus may have been associated with ureteral stenosis in this patient.In recent years,robot-assisted Boari flap has been reported,and its efficacy and safety have been confirmed (28,29).However,its high price is prohibitive.…”