Ureteral Reimplantation

The ureters are carefully spatulated along their anterior surface for 1 cm. Two incisions are made through the posterior wall of the sigmoid to accommodate the left and right

FIGURE5 ■ (A) Antimesenteric incision starting at rectosigmoid junction. (B) Transanal specimen retrieval in endoscopy bag. (C) Side-to-side anastomosis of posterior wall of pouch. (D) Submucosal ureteral implantation. (E) Completed ureterosigmoid diversion.

Native sigmoid fixation facilitates intracorporeal suturing.

FIGURE5 ■ (A) Antimesenteric incision starting at rectosigmoid junction. (B) Transanal specimen retrieval in endoscopy bag. (C) Side-to-side anastomosis of posterior wall of pouch. (D) Submucosal ureteral implantation. (E) Completed ureterosigmoid diversion.

ureters. The incisions are made such that each ureter has approximately 3 cm of length in the pouch for the creation of submucosal tunnels. The submucosal tunnels are created sharply in a superior to inferior fashion. The ureters are pulled through the neo-orifices and secured with a single 4-0 polyglecaprone suture. Eight French monopigtail stents are placed into each ureter and externalized through the anus. The distal margins of each ureter are anastomosed to the sigmoid mucosa using a combination of interrupted and running 4-0 polyglyconate suture. The sigmoid mucosa is then closed over the distal segments of the ureters using running 4-0 polyglyconate suture.

0 0

Post a comment