The application of the “omental wrapping” technique with autologous onlay flap/graft ureteroplasty for the management of long ureteral strictures

Wang, Jie; Zhang, Baiyu; Fan, Jie; Cheng, Sida; Fan, Shubo; Yin, Lu; Li, Zhihua; Guan, Hua; Yang, Kun‐Lin; Li, Xuesong

doi:10.21037/tau-21-305

Cited by 7 publications

(8 citation statements)

References 32 publications

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“…A well-vascularized omentum can supply needed nutrients to support ureteral health following ureteral surgery ( 6 ). An omental wrap can also be used to augment grafting for ureteral strictures, providing additional blood supply and support ( 7 ). This strategy can work for native tissue or for grafts, for example in wrapping a buccal graft ureteroplasty ( 8 , 9 ).…”

Section: Resultsmentioning

confidence: 99%

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Narrative review of flaps and grafts in robotic reconstructive urologic surgery

Doersch,

Hines,

Ajay

2024

Ann Laparosc Endosc Surg

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Background and Objective: Flaps and grafts are used for filling dead space, ureteral substitution, and as mesh alternatives. The surgical robot is invaluable in urologic reconstructive surgery due to the ability of the robot to reach the deep pelvis, its minimally invasive access, the ability to use indocyanine green to identify structures and assess tissue perfusion and viability, and ergonomics for the surgeon. Robotic reconstruction can involve tissue transfer in the form of flaps and grafts to provide form and function to organs that have been damaged by iatrogenic injuries, trauma, infections, cancer, radiation injury, or congenital abnormalities. Common flaps and grafts can be readily adapted to the robotic approach. In this literature review, we examine the robotic use of flaps and grafts in reconstructive urology. Methods: A thorough literature review was conducted via a PubMed search for predefined terms. Key Content and Findings: Flaps and grafts in reconstructive urology are used for interposition, ureteral substitution, and as mesh alternatives. Omental flaps are used for tissue interposition, or to provide structure and nutrients, and are easily employed with the robot. Various robotic applications of peritoneal flaps have been described. Vascular rectus abdominis musculocutaneous flaps are well-vascularized flaps that occupy dead space and provide structural support, which can be harvested readily with the robot. Sigmoid epiploica are an excellent flap for pelvic reconstruction. Gracilis flaps and fascia lata grafts are well-tolerated and provide space occupying tissue. Boari flaps aid in robotic ureteral reconstruction, especially in the setting of long defects. Oral mucosa is excellent for ureteral or bladder neck reconstruction. Rectal mucosa is well-tolerated and easy to harvest robotically for a variety of urinary tract reconstructive applications. The appendix or ileum can be interposed for repair of damaged ureters. Conclusions: Various flaps and grafts have been adapted for robotic reconstructive urology. As the field develops, refinement of techniques and innovation in flaps and employment of the robot will propel this field forward. More studies, especially comparative studies, are needed to elucidate the flaps and grafts that are most likely to be successful with the least morbidity for each use case.

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Section: Resultsmentioning

confidence: 99%

“…Buccal mucosa has been described as suitable robotic ureteral replacement tissue by multiple groups via multiple different approaches ( 8 , 51 , 52 ). Robotic ureteroplasty has also been performed successfully with lingual mucosa ( 7 , 49 ). Additionally, buccal ureteroplasty with the single port robot has been described ( 53 ).…”

Section: Resultsmentioning

confidence: 99%

Narrative review of flaps and grafts in robotic reconstructive urologic surgery

Doersch,

Hines,

Ajay

2024

Ann Laparosc Endosc Surg

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“…The principles of laparoscopic reconstructive surgery are consistent with those of open approaches and include tension-free, watertight and mucosa–mucosa anastomosis, gentle manipulation of the ureter, maximal protection of ureteric vascularization, and reinforcement of the blood supply 1 , 12 . Based on these principles, several technical difficulties must be considered.…”

Section: Discussionmentioning

confidence: 97%

“…The occurrence of these manifestations indicates the possibility of ureteral injury. Delayed diagnosis of ureteral injury may lead to ureteral stenosis or atresia, ureteric dilatation, hydronephrosis, urinary tract infection, and even progressive impairment of renal function 12 , which may need further intervention.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic ureteroneocystostomy with bladder flap for benign ureteral stenosis: our initial experience

Zhang,

Huang,

Xie

et al. 2024

Sci Rep

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To present our experience with laparoscopic ureteroneocystostomy with bladder flap (LUCBF) for treating benign ureteral stenosis and evaluate its feasibility and efficacy. The clinical data of 27 patients with benign ureteral stenosis who underwent LUCBF were retrospectively analyzed. After identification and excision of the ureteral stenosis segment, the healthy ureteral stump was dissected and incised longitudinally. A U-shaped or spiral bladder flap was harvested from the anterolateral bladder wall for ureteroplasty. All patients underwent LUCBF successfully, including 14 patients were combined with psoas hitch technique, between 90 and 220 min (median, 155 min). The median length of ureteral defect was 6 cm (range, 5–17 cm). The median blood loss was 40 ml (20–150 ml). The median indwelling time of double-J stent was 8 weeks (range, 4–8 weeks). Five patients (10.6%) suffered postoperative complications during the follow-up period (range, 12–48 months), including fever, hematuria, urinary tract infection and recurrent stenosis. The success rate was 96.3% (26/27). Patients with long ureter defects had longer operative time and more blood loss than short ureter defects. LUCBF was a safe and feasible technique for benign ureteral stenosis. Long ureter defect was related to longer operative time and more blood loss.

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“…The pedicled greater omentum ap is prepared by detaching from the greater curvature of the stomach and preserving the gastroepiploic vessels to keep the blood supply of the ap intact. The advantage of this technique is that the ap can be moved away from the greater omentum, thereby reaching the chest, pelvis, and bottom of the trunk where it cannot [11] .Based on these special biological characteristics of the greater omentum, it has been successfully used in general surgery, neurosurgery, cardiothoracic surgery, urological surgery, gynecological surgery and other surgical operations [11,12,13,14,15,16] .…”

Section: Introductionmentioning

confidence: 99%

Application of pedicled greater omentum flap tamponade combined with laparoscopic fenestration in diaphragmatic hepatic cyst

Chen

Jin

et al. 2022

Preprint

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Objective To investigate the efficacy and clinical application advantage of omental tamponade with vascular pedicle combined with Laparoscopic fenestration for the treatment of diaphragmatic hepatic cyst. Methods A total of 56 patients with diaphragmatic hepatic cysts underwent laparoscopic surgery in a single tertiary academic medical center from January 2010 to October 2020, including 21 patients (non-omental group) underwent laparoscopic fenestration of liver cysts, and 36 patients underwent laparoscopic liver cyst fenestration combined with vascular pedicle omentum tamponade (omental group). The general conditions and follow-up results of the two groups were compared and annalyzed.Results The operation time of the omental group was longer than that of the non-omental group (P = 1.358E-4). There was no significant difference in postoperative complications, postoperative laboratory values, hospital stay and hospital costs (P＞0.05). In the omental group, recurrence occurred in 1 of 35 patients (4.65%) who were followeded up 12 months after surgery. In the non-omental group , of the 21 patients followed, 8 patients (38.10%) recurred 12 months after surgery, and 3 patients (14.28%) recurred 6 months after surgery.Conclusion It is an effective method to prevent the recurrence of diaphragmatic hepatic cyst after laparoscopic fenestration by packing the cyst with vascularized omentum.

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The application of the “omental wrapping” technique with autologous onlay flap/graft ureteroplasty for the management of long ureteral strictures

Cited by 7 publications

References 32 publications

Narrative review of flaps and grafts in robotic reconstructive urologic surgery

Narrative review of flaps and grafts in robotic reconstructive urologic surgery

Laparoscopic ureteroneocystostomy with bladder flap for benign ureteral stenosis: our initial experience

Application of pedicled greater omentum flap tamponade combined with laparoscopic fenestration in diaphragmatic hepatic cyst

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