Retrospective Study on Safety and Efficacy of Transperitoneal Laparoscopic Surgery and Open Surgery for Retrocaval Ureter

Abstract

Introduction: Retrocaval ureter is a rare congenital anomaly which remains silent until the 3rd or 4th decade of life. But once a patient develops symptoms, it mandates treatment in the form of surgical management. Open surgery has traditionally been considered as the standard of care but it has its own downside or limitations. It requires a relatively large skin incision causing significant postoperative pain and thus prolonging convalescence. Transperitoneal laparoscopic approach is the preferred approach by most surgeons owing to large working space and familiar anatomy. Aim: To compare the safety and efficacy of transperitoneal laparoscopic and open surgery for definitive management of retrocaval ureter. Materials and Methods: Clinical data of fifteen patients, that underwent surgery for retrocaval ureter from December 2013 to January 2020 and the study of this data was done from June 2020, at Urology Department were analysed retrospectively. Out of 15 patients, seven were treated by open surgery while eight underwent transperitoneal laparoscopic surgery. Ureter was transpositioned to normal anatomic position followed by uretero-ureterostomy. Student t-test was applied to interpret and analyse the data obtained in both the groups using SPSS version 24. Results: Total of 15 patients data was studied (7 open surgery + 8 transpertional laparoscopic surgery, age 21-45 years). Intraoperative and postoperative data were compared between the transperitoneal laparoscopic and open surgery group. A statistically significant difference was found for operative time (p-value <0.001), estimated blood loss (p-value <0.05), analgesic requirement (p-value <0.001), drain removal (p-value <0.05) and hospital stay (p-value <0.001) between the two groups. Superficial surgical site infection was noted in two patients in open surgery group. For rest 13 patients postoperative period was uneventful. The follow-up of all patients was done for 12-36 months. Conclusion: Transperitoneal laparoscopic uretero-ureterostomy as a definitive treatment of retrocaval ureter is safe, effective and reliable option with less trauma and faster recovery. This minimally invasive technique can be considered as the first choice for treatment of retrocaval ureter on account of familiar anatomy and easier learning curve in contrast to retroperitoneal laparoscopic or robotic surgery.