FIELD: medicine.
SUBSTANCE: invention refers to medicine, particularly to operative urology. Laparoscopic ureter is excised and cut off along border of stricture or obliteration within healthy tissue, ureter is mobilized proximally by 7-10 cm depending on thickness of muscular layer and fatty tissue. A urinary bladder wall is incised to form an anastomosis without tension. Tightening the ureteral catheter from the urinary bladder is followed by measuring the length of the urinary tract defect. Then ureter is removed outside through laparoscopic port and ureter is sputted along anterior medial surface 1 cm long. Pre-prepared buccal graft of required size is fixed along whole length of proximal edge of ureter by continuous suture with monocryl 4/0. An internal drainage stent N7 Ch is inserted, and the buccal graft is closed above the stent with a continuous external monocryl suture 4/0, not reaching 1 cm to its distal edge. On free edge of buccal graft monocryl thread 4/0 is laid and knot is fastened, after which buccal ureter transplant is immersed through laparoscopic port into abdominal cavity. In the bladder wall an intermuscular tunnel is formed in a distal direction, the mucous membrane is exposed and pulled up by the suture, buccal transplant is delivered through a tunnel; its edges are anchored to the edges of the bladder mucosa by single interrupted sutures of vicryl 4/0. Bladder wall defect is closed transversally to the incision with continuous monocryl 4/0 suture. Then, the omentum flap is cut out on feeding pedicle 3 cm wide and the omentum flap is placed without tension over the entire surface of the buccal graft and the implantation site in the bladder, thereafter, the omentum flap is fixed with single monocrysular sutures 4/0 to a buccal transplant and a bladder wall, a drainage is placed in the abdominal cavity. Trocars are removed under video endoscopic control, carbon dioxide is desufflated, sutures and aseptic dressings are applied on the skin.
EFFECT: method enables replacing the entire affected lower 1/3 of the ureter in the patients with prolonged postradiation strictures and ureter obliteraions, avoiding traumatic mobilization of adjacent organs from postradiation conglomerates and recovering the injured part of the ureter, reducing the extent of the surgical intervention, its length and intraoperative blood loss.
1 cl, 2 ex
