A surgeon is performing a right-sided laparoscopic hemicolectomy and accidentally clips and divides a tubular structure thought to be the ureter. Intraoperatively, urine is seen. The correct immediate step and subsequent repair are:
- A Place a drain and observe — most ureteric injuries heal spontaneously
- B Identify the defect immediately; perform primary uretero-ureterostomy over a JJ ureteric stent if the injury is recognised intraoperatively ✓
- C Convert to open and perform nephrectomy
- D Place a nephrostomy tube postoperatively and allow spontaneous healing
Correct answer: B. Identify the defect immediately; perform primary uretero-ureterostomy over a JJ ureteric stent if the injury is recognised intraoperatively
Explanation
Intraoperative ureteric injury recognised at the time of surgery should be repaired immediately. For injuries to the mid-ureter, primary uretero-ureterostomy (end-to-end anastomosis) over a JJ (double-J) ureteric stent with fine absorbable sutures is the standard repair. Delayed recognition leads to urinoma and renal deterioration; immediate repair has the best outcomes.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.