Extraperitoneal versus transperitoneal approach of laparoscopic ureterolithotomy in selected patients.

OBJECTIVE: To evaluate laparoscopic ureterolithotomy between extraperitoneal and intraperitoneal approach in patients with failure for Extracoporeal shock wave lithotripsy (ESWL) and endoscopic procedure of stone removal.

MATERIAL AND METHOD: A retrospective review was performed in 39 patients (40 stone units) underwent laparoscopic ureterolithotomy (extraperitoneal or intraperitoneal approach) in Ramathibodi Hospital between July 1997 and December 2007. The patients who had a large, impacted ureteric stone more than 1.5 cm or after failure of ESWL and endoscopic procedure were included. The data was collected and compared in operative time, estimated blood loss (EBL), duration of retaining drain (days) and complications.

RESULTS: The EBL, operative time and duration of retaining drain were 100 cc, 125.8 minutes and 3 days in the extraperitoneal group and 51 cc, 128 minutes and 5.8 days in the intraperitoneal group, respectively. The duration of retaining drain in the transperitoneal group was significant longer than the extraperitoneal group (p = 0.002). The EBL, operative time and complication were not significantly different between the two groups.

CONCLUSION: There does not seem to be a clear advantage to using a transperitoneal versus extraperitoneal approach for laparoscopic ureterolithotomy, depending on physician preference.