Operative note 24 Advanced

Retroperitoneal fibrosis surgery

What it does: free ureters trapped in scar behind the bowel.

Stent both ureters first. Marks and protects.
Both sides, even if 1 is blocked.
Midline cut. Peritoneum opened between duodenum and the inferior mesenteric vein.
Find ureters high up. Dilated. Not yet in scar.
Sharp, then blunt, freeing of the whole segment.
Biopsy the scar. Exclude lymphoma, cancer.
Then either: tuck the ureters inside the tummy, or move them sideways with fat between, or wrap each in omentum. (Omentum = the stomach's fatty apron. Free it off the colon, split in the midline.)

From the UroRef Operative Quick Guide.