Laparoscopic treatment of retroperitoneal fibrosis: report of two cases and review of the literature

Abstract

SUMMARY:Objectives: We present the results of treatment by laparoscopy of two patients with retroperitoneal fibrosis and review the literature since 1992, when the first case of this disease that was treated using laparoscopy was published. We also discuss the contemporary alternatives of clinical treatment with corticosteroids and tamoxifen.Case report: Two female patients, one with idiopathic retroperitoneal fibrosis, and other with retroperitoneal fibrosis associated with Riedel's thyroiditis, were treated using laparoscopic surgery. Both cases had bilateral pelvic ureteral obstruction and were treated using the same technique: transperitoneal laparoscopy, medial mobilization of both colons, liberation of both ureters from the fibrosis, and intraperitonealisation of the ureters. Double-J catheters were inserted before the operations and removed 3 weeks after the procedures. The first patient underwent intraperitonealisation of both ureters in a single procedure. The other had 2 different surgical procedures because of technical difficulties during the first operation. Both patients were followed for more than 1 year and recovered completely from the renal insufficiency. One of them still has occasional vague lumbar pain. There were no abnormalities in the intravenous pyelography in either case.Conclusions: Surgical correction of retroperitoneal fibrosis, when indicated, should be attempted using laparoscopy. If possible, bilateral ureterolysis and intraperitonealisation of both ureters should be performed in the same operation.

Laparoscopic ureterolysis with omental wrap for idiopathic retroperitoneal fibrosis

“…Importantly, recurrence of obstruction can be asymptomatic and therefore a long‐term follow‐up is necessary. Although there are several reports of minimally invasive approaches to ureterolysis, detailed descriptions of technique and decision‐making on approach are rare (Table 1) [2–17]. We present four patients who had a laparoscopic ureterolysis with omental wrap using four separate techniques.…”

“…Classically ureterolysis has been performed through a large incision often in the midline, yet several groups have reported minimally invasive approaches [2–17]. Besides the obvious aesthetic benefits of laparoscopy, Srinivasan et al.…”

Retroperitoneal Fibroziste Cerrahi Tedavi: Nelere Dikkat Edilmeli?

“…Üreteroliziste uyulması gereken temel prensipler açık ve minimal invazif yaklaşımlar arasında farklılık göstermez (1). Ancak özellikle laparoskopik ve robotyardımlı laparoskopik üreterolizis serilerinde, cerrahın tercihine ya da tecrübesine dayandırdığı bazı seçimler yapabileceği ve buna göre teknikte bazı minör değişimler olabileceği belirtilmiştir (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Örneğin, ameliyattan önce yerleştirilen üreteral stentlerin yerin-de bırakılması ya da ameliyat bitiminde çıkartılması, intraperitonealizasyon ile yetinilmesi ya da hem intraperitonealizasyon hem de omental sarma yapılması, sadece üst üriner sistemin dilate olduğu taraftaki üreterlerin serbestleştirilmesi ya da standart olarak bilateral serbestleştirme yapılması gibi tercihler çoğunlukla cerrahın seçimine bırakılmıştır.…”

Complicaciones en cirugía laparoscópica urológica

“…La ureterolisis laparoscópica es una opción quirúrgica frente a la cirugía abierta, aunque la experiencia acumulada es limitada para precisar su rol en el tratamiento de la fibrosis retroperitoneal. Las tasas de complicaciones y conversión reportadas llegan a un 30% y 15% respectivamente [32][33][34] . Nosotros hemos realizado ureterolisis e intraperitonización ureteral laparoscópica en 2 pacientes con fibrosis retroperitoneal.…”