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

Abstract Objective: This study was designed to evaluate the safety and clinical efficacy of using laparoscopic Boari flap for repair of long-segment ureteric avulsion or ureteric stricture of the middle and lower ureters,and to summarize the experiences.We can providing a safe and viable treatment option for patients with middle and lower ureteral defects. Methods: We retrospectively collected data from seventeen patients who underwent laparoscopic Boari flap for repair of long-segment ureteral defects between October 2018 and March 2023,six of whom underwent Boari flap-psoas hitch,and assess patient demographic characteristics,intraoperative variables,postoperative complications,and follow-up outcomes. Results: The median length of ureteral avulsion or ureteral stricture was 8 cm(range,3-16 cm).The median operative time was 180 min(range,155-240min).The median estimated blood loss was 150mL(range,20-200 mL). The median postoperative hospital stay was 9 days(range,7-17 days),with no major procedure-related complications in the perioperative period.Postoperative follow-up (rang,1-65months) CTU or ultrasonography showed that one patient developed ureteral stricture and severe hydronephrosis 1 year after surgery,and the hydronephrosis improved 3 months after placing 2 double J-tubes.The remaining sixteen patients showed no significant complications on postoperative review. Conclusion: Laparoscopic Boari flap for repair of long-segment ureteric avulsion or ureteric stricture of the middle and lower ureters has good safety and feasibility.For ureteral avulsion,we prefer the psoas minor tendon as the recommended anchor for bladder suspension to avoid the femoral or genitofemoral nerve and the length-to-base ratio of the flap was up to 4:1 with good blood supply.