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Clinical report of three cases of abdominal cocoon since 1999. On the side of the abdominal transverse incision, ureter lumbar (abdominal plain film is equivalent to the lumbar 3,4 vertebral level) stone removal was performed in 48 cases, compared with conventional lumbar incision, it has less trauma, less blood loss, a clear operative field, less postoperative wound pain, and quick recovery, as reported below.

Materials and Methods:

1.1 General Information

The group consisted of 48 cases, 30 male cases, and 18 female patients. Aged between 26 to 47 years, with an average age of 34.6 years. There were 34 cases on the right side and 14 cases on the left side. All were unilateral and associated with hydronephrosis, meeting the indications for surgery.

1.2 Surgical Procedures

Before surgery, conventional positioning photos were taken one hour prior. Continuous epidural block was selected. The patient was placed in the contralateral hemi-lying position. The surgeon stood on the ventral side of the patient. The incision was made from the anterior axillary line at the umbilical plane to the center line extended to the rectus abdominis. About 6 ~ 8 cm cut was made through the skin and subcutaneous tissue. Using hemostat, the lateral end of the external oblique, abdominal oblique, and transverse abdominal muscles were softened, directly accessing the extraperitoneal fat layer and cutting part of the myometrium. Then, the part of the abdomen's rectus sheath around was cut, making it easy to pull the rectus medially for separation along the peritoneal rear, opening the peritoneum to the midline to reveal the ureter. Touching the stones, parts of the ring clamp controlled the stone up and down the proximal ureter, preventing calculus movement while cutting the ureter sheath and ureter to remove stones. The ureter built-in T-tube drainage was used. Ureteral incision was sutured with absorbable sutures. Incision beside the rubber tube drainage leads from the bottom of the abdominal incision. The incision was then sutured.

2 Results:

Of the 48 cases, the success rate of stone removal was [ ], with no postoperative wound pain, no blood in the urine, and no wound infection. Patients could get out of bed the next day and resume their diet. Upper ureteral stones more than 3 cm were found clinically located on the abdominal plain film, equivalent to between the 3rd and 4th vertebrae in the waist, marked on the surface at the umbilical plane. This facilitates accurate positioning of the incision, taking into account the injury to the iliohypogastric nerve and ilioinguinal nerve, with almost no bleeding, pushing easily from the peritoneum and closing the incision, a clear operative field, simple operation, less postoperative wound pain, and quick recovery. On the other hand, in case the stone moves to the pelvis, it is also easy to extend the incision to the waist for stone removal.

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