Laparoscopic pyeloplasty in children: Long‐term outcome

Abstract

Objectives: To asses the safety and efficacy of laparoscopic pyeloplasty in pediatric patients. Methods: Data of pediatric patients under the age of 14 years, who had undergone laparoscopic pyeloplasty from January 2000 to December 2005, were prospectively analyzed. The various parameters recorded were: operative time, blood loss, need for analgesics, intra/postoperative complications, hospital stay and postoperative outcome. Success was defined as either symptomatic improvement and/or better drainage on postoperative isotope renography Results: There were 53 patients with a mean age of 9.12 years (1-14 years) and a male to female ratio of 4.3:1. Dismembered pyeloplasty was done in 41 patients and Foley Y-V plasty in 12 patients via a transperitoneal approach using 3 ports in 50 children or 4 ports in 3 children. Mean operative time was 181 min (78-369); mean blood loss was 118.01 mL (50-250) with a mean hospital stay of 5.05 days (2-11). Conversion to open surgery was required in 4 (7.54%) patients. Follow-up renograms were available in 49 patients, which showed improvement in drainage in 44 patients and an obstructed pattern in five; of these, two patients had significant deterioration in split function. Two patients among the obstructed group underwent redo pyeloplasty by open technique while the other three elected for a conservative approach. Thus at a mean follow up of 24.58 months (4-45) the overall success rate was 89.75%. Conclusions: Laparoscopic pyeloplasty is a safe and effective, minimally invasive procedure in pediatric patients with a good intermediate term success rate and minimal morbidity.

Functional outcome after laparoscopic dismembered pyeloplasty in children

“…There was no significant difference in kidney function at the site of pyeloplasty between measurement preoperatively and 3 and 12 months after surgery. This is consistent with recent reports on smaller groups of patients [3,6,17,18]. Moreover, our data revealed a significant improvement in the urodynamic obstruction 1…”

“…Our results are consistent with previous reports [17,18], confirming that functional results after laparoscopic dismembered pyeloplasty are comparable to those of open surgery but offer the advantages of minimal invasive access. We conclude that laparoscopic pyeloplasty À in some centers for pediatric urology e might move toward replacing the open surgical procedure in the operative treatment of UPJO.…”

The transition from open to laparoscopic pediatric pyeloplasty: A single-surgeon experience

“…Nonetheless, our reported LOS was much less than most laparoscopic pyeloplasty series, which range from a mean of 29 h to 7 days [5,6,8,11,14]. In the Ansari series of 41 transperitoneal laparoscopic pyeloplasties, the mean LOS was 5 days [13]. This was similar to the Piaggio group who reported on 37 transperitoneal laparoscopic pyeloplasties and demonstrated a mean length of stay of 2.4 days.…”

Transmesocolic laparoscopic pyeloplasty in children: A standard approach for the left-side repair

“…Except for a longer operative time, the results have been comparable with those of open repair, even in infants [5,6,12,13]. Although considered technically demanding, the retroperitoneal approach has been preferred by some surgeons because of better tolerance of potential urinary leakage into the retroperitoneal space and a lower risk of injury to intraperitoneal organs [9,10,11].…”