Introduction: Radical cystectomy (RC) with urinary diversion (UD) is the gold-standard treatment for muscle-invasive bladder cancer. Ureteroenteric (UE) anastomotic stricture is a known complication, with sequelae such as kidney injury (KI) and urinary tract infection (UTI), requiring intervention. UE strictures present multifactorial etiology, yet, periureteral fibrosis and scarring secondary to ischemia or urine leakage at the anastomotic site are thought to be the main reasons. Classical open revision was the gold-standard for these strictures; however, minimally invasive approaches are arising. Methods: An open RC (ORC) with Bricker UE anastomosis in ileal conduit (IC) complicated with bilateral stricture after 2 months (M). Patient presented recurrent UTI and KI, so, bilateral percutaneous nephrostomies (PN) were placed. Endoscopic balloon dilation was attempted, but impossible on the left. Thus, we performed a laparoscopic (lap) 5-port bilateral UE re-implantation due to uretero-ileal stenosis, 6.5M after ORC. Results: Extensive peritoneal adhesions and fibrotic peri-ureteral tissue were found. Identification of anatomical landmarks, careful dissection and structures release was done. After IC release, we dissected the right ureter (the least fibrotic and with previous mono J stent) until the uretero-ileal junction. The left ureter revealead marked fibrosis and devascularization. After maximum fibrosis excision and ureteral spatulation, we performed an UE Bricker re-implantation over 7Ch mono J stents, using 4-0 Vicryl in 8 simple interrupted sutures, bilaterally. On the right, we used the previous site on the IC for re-implantation. On the left, due to fibrosis, we chose a different location. Operative time was 2 hours. Stents were removed after 4 weeks (right) and 2M (left). Patient had some UTI, but remains stents-free 9M after. Conclusions: Laparoscopy allows direct visualization of known UE anastomosis issues that contribute to strictures: ureteral skeletonization with blood supply compromise leading to ischemia; not tension-free and water-tight anastomosis, facilitating urine leak; tension and angled pathway of left ureter under the sigmoid mesocolon. In re-implantation surgery, correcting these problems is challenging, but essential for success. Careful dissection, using traction and counter-traction, anatomical planes and structures correct identification and preservation is mandatory. After maximum possible excision of fibrosis, suture with mucosa apposition rather than strangulation is required for a quality UE anastomosis. SOURCE OF Funding: None
