Laparoscopic pyeloplasty in infants: Single-surgeon experience

Chandrasekharam, V.V.S.

doi:10.1016/j.jpurol.2015.05.013

Cited by 22 publications

(18 citation statements)

References 23 publications

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“…Several earlier reports have demonstrated the safety and efficacy of laparoscopy for primary pyeloplasty in children, including infants [9]. LP for primary PUJO in children has been shown to be comparable to open pyeloplasty in terms of safety and efficacy, with shorter hospital stay for LP [10].…”

Section: Discussionmentioning

confidence: 94%

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Laparoscopic redo pyeloplasty in children: comparison with laparoscopic primary pyeloplasty

Chandrasekharam

2020

J Ped Endosc Surg

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Purpose Laparoscopic pyeloplasty has become fairly established in children. However, there are only a few reports on the use of laparoscopy for redo pyeloplasty. Laparoscopic redo pyeloplasty for previously failed open pyeloplasty can be quite challenging, due to the extensive adhesions and fibrosis following the previous operation. In this paper, we compare our experience with laparoscopic primary pyeloplasty with laparoscopic redo pyeloplasty after previous failed open pyeloplasty in children.Methods We retrospectively reviewed all pediatric laparoscopic pyeloplasties performed by a single surgeon over a 2-year period. Data were retrieved from operative and follow-up records. Patients undergoing primary pyeloplasty were compared to those undergoing redo pyeloplasty. Clinical, operative and follow-up data were compared between the two groups. Ultrasound examination was repeated 3-6 months after the surgery; success of pyeloplasty was defined as absence of symptoms and improvement in hydronephrosis compared with pre-operative testing. Statistical analysis was done using software; Mann-Whitney U test and Fisher exact test were used where applicable, and p < 0.05 was considered significant. Results Of 104 laparoscopic pyeloplasties, 95 were primary and 9 redo pyeloplasties. All redo pyeloplasties had previous failed open pyeloplasty done elsewhere (once in 7 and twice in 2). Laparoscopic pyeloplasty was done using three ports, with antegrade double J stent placement at the time of pyeloplasty, which was removed after 4-6 weeks. The comparison between the two groups is given in Table 1. The mean age at surgery and the laparoscopic operative time was significantly higher (40% higher) in children undergoing redo pyeloplasty. The length of stay and post-operative complications were not significantly different between both the groups. At follow-up, laparoscopic pyeloplasty was considered successful in 74/74 (100%) primary and 9/9 (100%) redo pyeloplasties. Conclusions In this large single-surgeon series, laparoscopic redo pyeloplasty for previous failed open pyeloplasty in children was found to be feasible, safe and effective, comparable to primary laparoscopic pyeloplasty. However, even in expert hands, the operating time was significantly more for redo cases.

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Section: Discussionmentioning

confidence: 94%

“…Another disadvantage with RALP in children is the use of larger ports and instruments in children. Whereas LP can be performed using 5 mm and 3 mm ports [9], RALP is usually performed using 12 and 8 mm ports [17]. The results of LP and RALP are comparable with RALP offering no additional advantage to the patient.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic redo pyeloplasty in children: comparison with laparoscopic primary pyeloplasty

Chandrasekharam

2020

J Ped Endosc Surg

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“…Since then, a few pediatric large se- Conversion to open procedure 0 (8). However, while early series had reported anastomotic stenosis in babies (9,10), subsequent studies demonstrated feasibility irrespective of patient age and weight (6,7,(11)(12)(13). LP has been thought to be a technically challenging procedure in children.…”

Section: Discussionmentioning

confidence: 99%

“…The role of LP in youngers and mainly in infants is less well defined. It has just slowly emerged as safe and an alternative to the open procedure (6).…”

Section: Introductionmentioning

confidence: 99%

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

2020

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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.

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“…1,3,[5][6][7] As crianças com menos de 3 anos de idade recuperam rapidamente da cirurgia por via convencional, pelo que estes benefícios podem não se aplicar a esta faixa etária. Desta forma, existem muitos autores que não realizam esta cirurgia abaixo dos 3 anos de idade.…”

Section: Discussionunclassified

Pediatric laparoscopic pieloplasty

Morão

Silva

Mota

et al. 2017

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ResumoIntrodução: A obstrução da junção pielo-ureteral (OJPU) é a causa congénita mais comum de uropatia obstrutiva na criança. O objectivo deste trabalho é documentar a experiência desta Unidade de Urologia Pediátrica relativamente às primeiras 20 pieloplastias realizadas por via laparoscópica. Material e Métodos: Estudo retrospectivo em que foram incluídos vinte doentes com o diagnóstico de OJPU submetidas a pieloplastia por via laparoscópica, por um único cirurgião, no nosso Hospital, no período compreendido entre Novembro de 2010 e Dezembro 2014, tendo completado pelo menos um ano de seguimento. O sucesso do procedimento foi definido como ausência de conversão, resolução dos sintomas e melhoria dos critérios imagiológicos. Resultados: A mediana da idade à data da cirurgia foi de 9,5 anos (variando entre os 10 meses e os 17 anos). Constatou-se a existência de obstrução intrínseca em sete casos, obstrução extrínseca em 12 casos, sendo que num caso se verificaram as duas situações. O tempo operatório mediano foi de 235 minutos (variando entre 165 e 275 minutos), tendo havido necessidade de conversão para abordagem laparotómica em dois casos (10%). O tempo mediano de internamento foi de dois dias (variando entre 2 e 5 dias). Em quatro casos (20%) registaram-se complicações pós-operatórias precoces e houve necessidade de re-intervenção em dois casos (10%) durante o seguimento. O tempo mediano de seguimento foi de 33 meses (variando entre 12 e 60 meses). No seguimento, todos excepto dois doentes estavam assintomáticos. Constatou-se melhoria imagiológica da hidronefrose em todos os doentes excepto em um, apesar de não apresentar padrão obstrutivo no renograma. Conclusão: Os nossos resultados são consistentes com os da literatura publicada, com taxas de sucesso comparáveis com a abordagem por via laparotómica e com as vantagens da cirurgia minimamente invasiva. Palavras-chave: Criança; Laparoscopia; Obstrução Ureteral/cirurgia; Pelvis Renal/cirurgia.

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Laparoscopic pyeloplasty in infants: Single-surgeon experience

Cited by 22 publications

References 23 publications

Laparoscopic redo pyeloplasty in children: comparison with laparoscopic primary pyeloplasty

Laparoscopic redo pyeloplasty in children: comparison with laparoscopic primary pyeloplasty

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

Pediatric laparoscopic pieloplasty

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