RESUMO
Chylous ascites is an infrequent complication of retroperitoneal surgery. We describe a patient who suffered massive chylous ascites after simultaneous pneumonectomy and laparoscopic excision of a post-chemotherapy tumor mass. After conservative management failed, exploratory laparoscopy identified the site of the leak, which was clipped and closed with fibrin glue. There has been no recurrence in the ensuing 5 years.
Assuntos
Ascite Quilosa/etiologia , Ascite Quilosa/cirurgia , Laparoscopia , Excisão de Linfonodo , Complicações Pós-Operatórias/cirurgia , Adolescente , Carcinoma Embrionário/cirurgia , Coriocarcinoma/cirurgia , Humanos , Masculino , Orquiectomia , Pneumonectomia , Espaço Retroperitoneal/cirurgia , Terapia de Salvação/métodos , Teratoma/cirurgia , Neoplasias Testiculares/cirurgiaRESUMO
PURPOSE: We present our initial experience with the laparoscopic Boari flap for long ureteral strictures. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.