Laparoscopic omentoplasty to support anastomotic urethroplasty in complex and redo pelvic fracture urethral injury patient
Epublication WebSurg.com, Oct 2015;15(10). URL: http://websurg.com/doi/vd01en4587
Introduction: The aim of this film was to test the feasibility, safety and efficiency of a new surgical technique using elaborated perineal anastomotic urethroplasty combined with laparoscopic omentoplasty for patients with complex pelvic fracture and for whom a previous urethral defect repair failed. Material and methods: We performed a prospective, observational, stage 2a study to observe treatment outcomes of combined perineal and laparoscopic approaches for urethroplasty in patients with complex and redo pelvic fracture urethral defects at a single center in Pune, India, between January 2012 and January 2013. Anterior urethral strictures were excluded. The primary aim of the study was to evaluate the efficiency of the surgical technique and the secondary aim was to test the feasibility and safety of the procedure. The procedure was considered as ineffective if any additional postoperative procedure was required. Results: Fifteen male patients with a median age of 19 years old were included. Seven patients were adolescents (12-18 years of age) and 8 patients were adults (19-49 years of age). The mean number of prior urethroplasties was 1.8 (1-3). All patients underwent elaborated bulbomembranous anastomosis using a perineal approach with inferior pubectomy combined with laparoscopic mobilization of the omentum into the perineum to wrap the anastomosis. In 15 patients, 14 (93.3%) had a successful outcome and the procedure failed in 1 patient (6.6%). A 14-year-old boy developed a recurrent stricture 2 months after the procedure, which was managed using an internal urethrotomy. Median follow-up was 18 months (13-24 months). Conclusion: Combining a laparoscopic omentoplasty with a membranobulbar anastomosis for complex and redo pelvic fracture urethral injury is a successful, feasible and safe technique, and with minimal additional morbidity for the patient. This technique offers the advantages of a perineal incision and allows to use the omentum in order to facilitate the anastomosis.