Laparoscopic ureteroplasty for the treatment of long ureteral strictures with appendiceal interposition and appendiceal onlay flap: technical description and initial experience

Background: Laparoscopic ureteral reconstruction using the appendix is a novel and minimally invasive technique for treating long ureteral strictures. This study aims to report our initial experience and outcomes of laparoscopic appendiceal onlay flap ureteroplasty (LAOU) and laparoscopic appendiceal interposition ureteroplasty (LAIU) in patients with long ureteral strictures. Methods: Data of 16 patients with right long ureteral strictures underwent either LAOU or LAIU between October 2021 and January 2025 in a single center were collected retrospectively. The pre-, intra-, and postoperative variables and follow-up results were analyzed. Results: Ten (62.5%) patients underwent LAIU, and six (37.5%) underwent LAOU. The mean stricture length was 3.2 cm (range, 2.0-5.0 cm), the operative time was 200.6 minutes (range, 150-240 minutes), the estimated blood loss was 84.4 mL (range, 50-200 mL), and the mean postoperative hospital stay was 5.9 days (range, 4-8 days). With a mean follow-up of 14.9 months (range, 3-30 months), the overall success rate was 93.8%. There was no significant difference in the parameters between LAOU and LAIU surgical procedures. Conclusions: Laparoscopic appendiceal ureteroplasty is a viable option for treating long-segment ureteral strictures on the right side. The choice between appendiceal onlay or interposition depends on the specific condition of the strictures.