Transmesocolic ureteral intraperitonealization: a new approach for laparoscopic treatment of retroperitoneal fibrosis

Retroperitoneal fibrosis (RPF) is characterized by the presence of an inflammatory fibrotic process in the retroperitoneum causing compression of the retroperitoneal structures including the ureters. The ureterolysis is the liberation of the incarcerated portion of the ureter, from its proximal healthy portion to the distal portion, generally free of fibrosis, below the iliac vessels. We report the transmesocolic ureteral intraperitonealization as a new approach for laparoscopic treatment of RPF.

A 52-year-old female patient diagnosed with idiopathic RPF was submitted to laparoscopic transmesocolic ureteral intraperitonealization after medical management failure. An open access using a Hasson trocar was placed through the umbilicus and two additional trocars were placed-10  mm in the midline at 6  cm below the umbilicus and a 5  mm in the midline at 6  cm above the umbilicus. The left mesocolon was incised 3  cm lateral to aortic pulsation and the left ureter was identified and dissected off the retroperitoneal mass. Lateral incised mesocolon was mobilized and wrapped posterior to the left ureter using a running suture.

Operative time was 2 hours. The mean blood loss was less than 100  mL. The patient was discharged painless on the second postoperative day. No complications were observed. Pathology showed fibrous tissue. An intravenous pyelography was performed at 6 months after the surgery and showed no ureteral obstruction. Serum creatinine level stabilized at 0.9  mg/dL.

The transmesocolic ureteral intraperitonealization for laparoscopic treatment of RPF is feasible and can be considered a potential alternative for traditional laparoscopic intraperitonealization.