Laparoscopic pyeloplasty in pediatric patients: The SGPGI experience

Abstract

Objectives:To determine the safety, efficacy and long-term outcome of laparoscopic pyeloplasty in pediatric patients.Materials and Methods:A prospective analysis of data of pediatric patients under the age of 15 years, who had undergone laparoscopic pyeloplasty from January 2000 to June 2008 was done. The various parameters analyzed were; operative time, blood loss, need for analgesics, intra/postoperative complications, hospital stay and postoperative outcome. Success was defined on the basis of either improvement in the symptoms/or better drainage on postoperative isotope renography.Results:A total of 82 patients with a mean age of 7.12 years (four months to 15 years) and male to female ratio of 4.3:1 were included in the study. Dismembered pyeloplasty was done in 70 patients and Foley Y-V plasty in 12 patients via transperitoneal approach using three ports in 79 or four ports in three children. Mean operative time was 151 minutes (78-369); mean blood loss was 88.01 ml (50-250) with a mean hospital stay of 5.05 days (2-11). Conversion to open surgery was required in four (4.87%) patients. Follow-up renograms were available in 74 patients who showed improvement in drainage in 69 patients and 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 rest three elected for conservative approach. At a mean follow-up of 41.58 months (8-75) the overall success rate was 91.89%.Conclusion:Laparoscopic pyeloplasty is effective and safe in children with minimal morbidity and gives excellent long-term results.

Subadventitial dismembered pyeloureteroplasty – new surgical technique for correction of uretero-pelvic junction stenosis

“…The other 2 serious complications (urinoma and sepsis) occurred in a group of patients without the use of ureteral stents. In this aspect, our data are corresponds to the literature, which indicate the same complications in the group of patients without ureteral stenting [9]. Among the of kidney abnormalities concomitant with the UPJ stenosis, the horseshoe kidney attracts attention.…”

“…The advantages of laparoscopic pyeloureteroplasty over open surgery are the possibility magnified vision, low morbidity regarding the postoperative analgesia and shorter hospital stay, minimal incision site scar. However, it is still a more lengthy procedure with higher re-treatment rate (7 -18%) as compared to OP [3,9].…”

Ureteropelvic junction obstruction (UPJ) due to congenital crossing of the renal vessels (CRV): Comparison of the pre‐ and postoperative features of UPJO with and without CRV

“…Maheshwari et al in a series of 82 patients encountered CV in seven children (8.5%) with age ranging from 4 months to 15 years (mean 7.12 years) 8 . In comparison, Assem et al reported an incidence of 17.39% in four out of 23 adolescents aged between 16 and 20 years 9 .…”

Hydronephrosis in Children Caused by Lower Pole Crossing Vessels—How to Choose the Proper Method of Treatment?

“…CVs are very rarely noticed in newborns and infants. According to the literature, the average age of patients with a CV is between 7 and 11 years and is statistically higher than in patients with pure intrinsic obstruction ( 8 – 12 ). In our material, the median age at surgery was 6 years in both groups.…”