Dorsal lumbotomy incision for pediatric pyeloplasty - a good alternative

Abstract

This study reviews the value and benefits of the dorsal lumbotomy incision (DL) for exposure of the pelviureteric junction (PUJ) in infantile and paediatric pyeloplasty. Ninety-one children underwent pyeloplasty for confirmed PUJ obstruction between January 1993 and December 1997. The conventional loin incision (CL) (n = 60) was used as the standard, to which DL (n = 31) was compared. Information on the duration of surgery, length of hospital stay, length of time to return to full oral intake, and complications was obtained retrospectively from the hospital chart. The results were analysed using a non-parametrical statistical analysis. Follow-up was between 6 months and 5 years (median 2.4 years). The median age at surgery was 1.5 years (1 month-14 years). The median operating time was similar in both groups (95 min). The median length of stay was 3 days for the DL group compared to 7 days for the CL group (P < 0.001). The length of hospital stay had no correlation to the patient's age at surgery or the type of postoperative analgesia used. The median time to return to full oral intake and unrestricted activity in the DL group was 43 h compared to 83 h for the CL group (P < 0.001). The surgeons found that there was better exposure of the PUJ in infants in the DL group compared to the DL incision. There were no operative complications related to the DL itself. At the time of last follow-up 3 children required re-operation for a failed pyeloplasty, 2 in the DL group. The results suggest that DL is a safe and reasonable alternative to CL in paediatric pyeloplasty and probably the incision of choice in infantile pyeloplasty.

Dorsal lumbotomy incision in paediatric pyeloplasty

“…In the classical lumbotomy the skin incision is vertical but we have used a transverse incision following Langer's lines. This has been found to be cosmetically more acceptable without compromising the adequacy of exposure 7,9 .…”

“…The dorsal lumbotomy incision provides direct access to the kidney and upper ureter and was first reported in 1870 by Simon and further developed by Gil Vernet 4,5 . Recently there has been a renewed interest in this incision for upper urological tract surgery 6−10 . The suggested advantages include a direct approach, minimal tissue trauma due to less disruption of muscles, less pain consequently less analgesic requirements and early return to oral feeds.…”

Miniature pyeloplasty as a minimally invasive surgery with less than 1 day admission in infants

“…Open dismembered pyeloplasty is usually associated with significant postoperative pain and morbidity due to the muscle-cutting loin incision, aesthetic sequelae and long convalescence [3,12]. The abovementioned dissatisfactions led to the development of minimal access alternatives in the form of endopyelotomy, laparoscopic and recently the robotically assisted techniques [7].…”

The role of endourology in ureteropelvic junction obstruction

“…Most pediatric surgeons are reluctant to recommend the procedure and prefer a classic pyeloplasty via a small lumbotomy. Their reported 96% to 98% success rate of pyeloplasty is obviously superior to the 65% success rate commonly seen with endourology [41][42][43]. Endourologic pioneers have nevertheless confirmed the interest of the technique in selected instances, obtaining an 86% to 88% success rate in such cases [43][44].…”