✦ Retroperitoneal Fibrosis Treatment

Omental Wrapping of Ureters

Q: Is omental wrapping always done with ureterolysis?

In most cases of RPF ureterolysis, omental wrapping is performed as a standard adjunct to reduce recurrence; it adds minimal operative time.

Q: What if the omentum is insufficient or previously removed?

If omentum is unavailable (previous omentectomy), lateralisation of the ureter to the lateral retroperitoneum is the alternative.

Q: Does omental wrapping affect bowel function?

Mobilising the omentum rarely affects bowel function significantly; a mild ileus for 1–2 days post-operatively is the most common temporary effect.

Protecting Freed Ureters with Omentum to Prevent Re-Entrapment

30–60 min (added to ureterolysis) PROCEDURE

3–6 Days HOSPITAL STAY

>85% (with ureterolysis) SUCCESS RATE

4–6 Weeks RECOVERY

What is Omental Wrapping of Ureters?

Omental Wrapping of Ureters is an adjunct procedure performed immediately after ureterolysis for retroperitoneal fibrosis. A tongue of well-vascularised greater omentum is mobilised from the transverse colon and wrapped around the freed ureters, interposing living tissue between the ureter and the fibrotic retroperitoneal mass. Omentum's anti-inflammatory and lymphangiogenic properties resist fibrotic re-encasement, significantly reducing the risk of ureteric re-entrapment after ureterolysis. The procedure is performed under general or spinal anaesthesia with a hospital stay of 3–6 Days.

All patients undergoing ureterolysis for retroperitoneal fibrosis where sufficient omentum is available and can be mobilised without tension. Patients must be adequately fit for anaesthesia and free from active systemic infection before proceeding.

How the Procedure Works

Omental Assessment

Following ureterolysis, greater omentum assessed for length and vascularity.

Omental Mobilisation

Omental tongue mobilised on the right gastroepiploic pedicle, preserving vascular supply.

Retroperitoneal Delivery

Mobilised omentum delivered to the retroperitoneum via a window in the mesentery.

Ureteral Wrapping

Ureter wrapped circumferentially in omentum along its freed length.

Securing & Closure

Omentum secured with absorbable sutures; retroperitoneum closed around wrapped ureters.

Outcomes

30–60 min (added to ureterolysis)DURATION

3–6 DaysHOSPITAL STAY

>85% (with ureterolysis)SUCCESS RATE

4–6 WeeksFULL RECOVERY

Who Needs This Treatment?

→Significantly reduces risk of ureteric re-entrapment by fibrosis.
→Well-vascularised omentum has natural anti-inflammatory properties.
→Provides a biologically active barrier between ureter and fibrotic mass.
→No synthetic material used — entirely autologous tissue.
→Performed at same operation as ureterolysis — no additional anaesthetic.
→Improves long-term success of ureterolysis in high-recurrence-risk patients.

"Wrapping the freed ureter in omentum is the best insurance we have against recurrent fibrotic entrapment. The omentum's unique biological properties make it the ideal biological shield for protecting ureteric patency."

— — Dr. Vipin Reddy, Consultant Urologist, Andrologist & Renal Transplant Surgeon

Common Questions

Frequently Asked

Is omental wrapping always done with ureterolysis?+

What if the omentum is insufficient or previously removed?+

Does omental wrapping affect bowel function?+

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