A Comparative Study Of Bladder-flap Ureterovesical Implantation: Laparoscopic Versus Open Surgery

Background and purpose:Laparoscopy has been used in urologic surgery only more than ten years history, but it has developed rapidly. Laparoscopy has been used in most urologic surgery, including laparoscopic ureterovescial implantation. As compared with open operation, laparoscopy has the advantages of minimal invasion, less suffering, quicker recovery, less complication and same long-term outcome.In the past three years, we have performed less than twenty transperitoneal laparoscopic bladder-flap ureterovesical implantation for ureterovesical obstruction. Our researches focus on evaluating the clinical efficacy of transperitoneal laparoscopic bladder-flap ureterovesical implantation versus the open surgery during the correspongding time period.Methods:1. Including and excluding atandard(1) Including standardChoose the cases of uretrovesical obstruction incluing congenital ureterovesical stricture, secondum stricture after ureterovesical implantation, ureterovesical obstruction after pelvic surgery.(2) Excluding standardWe rule out those cases operated concomitant with other surgery (such ascholecystectomy,gynecological surgery, et al) in the case data was interfered.2. Assemble the data(1) Between January 2004 and June 2006 data were respectively obtained on our19 consecutive cases of ureterovesical obstruction patients who were operated by laparoscopic bladder-flap ureterovesical implantation. We gathered the detailed clinical data of these patients, including age, total operation time, blood loss, time to oral liquids, time of intravenous antibiotic, time of drainage, time of postoperative analgesia, postoperation hospital stay, postoperative complications.(2) Between January 2004 and June 2006 data were respectively obtained on our20 consecutive cases of ureterovesical obstruction patients who were operated by open bladder-flap ureterovesical implantation. We gathered the detailed clinical data of these patients, including age, total operation time, blood loss, time to oral liquids, time of intravenous antibiotic, time of drainage, time of postoperative analgesia, postoperation hospital stay, postoperative complications.3. Data analyzing:(1) We evaluated the role of the laparoscopic bladder-flap ureterovesical implantation versus open surgery by analyzing the data of the age, total operation time, blood loss, time to oral liquids, time of intravenous antibiotic, time of drainage, time of postoperative analgesia, postoperation hospital stay, postoperative complications.(2) All the data were analyzed by SPSS11.0 for windows. We chose different statistical method depended on the different data information.Result:1. Between January 2004 and June 2006, we treated 19 cases by laparoscopic bladder-flap ureterovesical implantation , all operations were successful and no conversion to open operation. Mean operative time was 131.5 minutes (110-180min), mean estimated blood loss was 70 ml (40-150ml), postoperativehospital time was 8.4 d (7-14d).2. Between January 2004 and June 2006, we treated 20 cases by open bladder-flap ureterovesical implantation , all operations were successful. Mean operative time was 135.5 minutes (100-195min), mean estimated blood loss was 160 ml (100-450ml), postoperative hospital time was 10.6 d (9-17d).3. Comparing the results of laparoscopic bladder-flap ureterovesical implantation with open surgery, the age and the mean operative time was no significant differences, but the mean volume of blood loss, time to oral liquids, time of intravenous antibiotic, time of drainage, time of postoperative hospital time, and the postoperative complications were statistically significant different. The laparoscopic approach was more minimally invasive than the open approach in the operation of bladder-flag ureterovesical implantation.Conclusion:Compared with open surgery for ureterovesical obstruction, Transperitoneal laparoscopic bladder-flap ureterovesical implantation is a minimally invasive, less suffering, excellent anti-urine reflux effect; quicker recovery approach for treatment of ureterovesical obstruction.