The outcomes of mini-laparoscopic pyeloplasty in children - brazilian experience

Abstract

Objetive: Pelvicureteric junction (PUJ) obstruction is the main cause of hydronephrosis in childhood. Open pyeloplasty has been the gold standard treatment of this condition with success rate above 90%. The role of laparoscopic pyeloplasty (LP) in children is less well defi ned and has slowly emerged as an alternative procedure. We report outcomes of our initial experience with LP in 38 children from 2 months of age. Materials and Methods: From June 2015 to December 2017 38 children aged 2-60 months (mean age 1.7 years) underwent LP for correction of PUJ obstruction. The mean pre operative anteroposterior diameter of the renal pelvis (APD) was 43,5mm and all patients had hydronephrosis (APD 21.4-76 mm) and obstructed curve on diuretic renogram. Anderson-Hynes pyeloplasty was the performed technique. Results are reported. Results: Mean operative time was 107 minutes (70-180) with no conversion to open procedure. Pain control was needed mainly in the fi rst 12hs. Mean hospitalization was 2 days (1-5). There were complications in 5 children not affecting the fi nal outcome. Two patients had a re-obstruction requiring a second procedure with good result. The mean follow up was 18 months (13-36). The mean reduction on the postoperative APD was 41%-p<0,001 (end APD 5 to 41mm). Overall success rate was 94,7%. All children had good cosmetic results. Conclusions: This is a small series limited by short follow up, however its data suggest that LP has good functional and cosmetic results, not compromising the success of the open procedure, regardless patient age.

Modified Dismembered Technique of Laparoscopic Transperitoneal Pyeloplasty in Children

“…Over the past two decades, laparoscopic pyeloplasty (LP) has gained more and more popularity and become the method of choice for the surgical correction of ureteropelvic junction obstruction (UPJO) by many authors (Turrà et al, 2016). Its success rate is greater than 95% which is equivalent to that of the open procedure with the added value of being minimally invasive, more magnification, less pain, early post-operative recovery, minimal wound complications and better cosmesis (Leonardo et al, 2020).…”

Multicenter comparative study of open, laparoscopic, and robotic pyeloplasty in the pediatric population for the treatment of ureteropelvic junction obstruction (UPJO)

“…Although MIS techniques are associated with a longer operative time compared to open procedures, they have shown benefits in terms of shorter postoperative hospital stay and lower morbidity (4)(5)(6). Nevertheless, LP is technically demanding and has a long learning curve (7,8).…”

Salvage minimally invasive robotic and laparoscopic pyeloplasty in adults: a systematic review

“…Despite multiple reviews published on the topic, there is a lack of clarity to the success rate and complication rates of salvage or redo pyeloplasty in the adult population with the minimally invasive techniques. As the pediatric population carries a different approach, given the technical difficulties in operating on small children compared to full-grown adults in addition to the long learning curve, the success rate of these procedures conducted in adult life might carry a different operative outcome [ 15 , 16 ]. Therefore, we aimed to conduct a systematic review of the literature to determine the safety and efficacy of salvage or redo laparoscopic and robotic pyeloplasty after a failed first attempt of repair in adults.…”