Laparoscopic Transposition of Lower Pole Crossing Vessels (Vascular Hitch) in Children with Pelviureteric Junction Obstruction: How to Be Sure of the Success of the Procedure?

Miranda, Márcio Lopes; Pereira, Luiz Henrique Ferraz; Cavalaro, Márcia Alessandra; Pegolo, Patrícia Carvalho; Oliveira-Filho, Antônio Gonçalves de; Bustorff‐Silva, Joaquim Murray

doi:10.1089/lap.2015.0153

Cited by 19 publications

(9 citation statements)

References 23 publications

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“…The UPJO by CV is intermittent and must be suspected in older children with recurrent renal colic pain and hydronephrosis. The renal function may be normal in children with UPJO without Urinary Tract Infection (UTI) (1,10,15,16). In our series, only three children had a major loss of kidney function, probably because of the high delay in the diagnosis (patients with hydronephrosis >4 cm).…”

Section: Discussionmentioning

confidence: 63%

“…Transl Pediatr 2016;5(4):256-261 tp.amegroups.com inserting percutaneously into the renal pelvis a fine-needle evaluating the ureteral opening pressure with a column device before and after the procedure was completed (1,8).…”

Section: Discussionmentioning

confidence: 99%

“…Uretero-pelvic-junction obstruction (UPJO) may be caused by intrinsic disorganization or by extrinsic compression from crossing vessels (CV); extrinsic causes usually present symptomatically in older children. The association was first described by Von Rokitansky in 1842 (1)(2)(3). Open or Laparoscopic Dismembered Pyeloplasty is the gold standard procedure to treat UPJO since the procedure was first described by Anderson and Hynes (AHDP) in 1949 (4).…”

Section: Introductionmentioning

confidence: 99%

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Laparoscopic transposition of lower pole crossing vessels (vascular hitch) in children with pelviureteric junction obstruction

Esposito¹,

Bleve²,

Escolino³

et al. 2017

Transl. Pediatr.

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We believe that Vascular Hitch is less technically demanding than laparoscopic pyeloplasty, resulting in a lower complication rate and a significantly reduced hospitalization. The results of our study allow us to conclude that laparoscopic VH may be a safe, feasible, and attractive alternative to treat obstructed hydronephrosis due to CV presenting a useful alternative to AHDP in the management of symptomatic children where CV are deemed the sole aetiology. We recommend careful patient selection based on preoperative clinical and radiologic findings that are diagnostic of extrinsic-UPJO, combined with intraoperative-DT to confirm the appropriate selection of corrective procedure.

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Laparoscopic transposition of lower pole crossing vessels (vascular hitch) in children with pelviureteric junction obstruction

Esposito¹,

Bleve²,

Escolino³

et al. 2017

Transl. Pediatr.

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“…In the last decade, many authors have wondered whether Hellstrom VH can be considered a valid alternative to DP in presence of CV [12,16,24,25], considering the advantages of this technique: surgical repair without opening the collecting system, leaving the UPJ intact, eliminating the risk of leakage or urinoma and preserving the pyelo-ureteral motility peristalsis. This procedure avoids the technical challenge of pelvi-ureteric anastomosis with a low complication rate and operative time [25,26]. During the operation, if a CV is present, it can be difficult to determine whether it is an incidental finding or plays a significant role in the obstruction [25].…”

Section: Discussionmentioning

confidence: 99%

Uretero-pelvic junction obstruction with and without crossing vessels: surgical outcome in a single center experience

et al. 2020

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Purpose Uretero-pelvic junction obstruction is the most common cause of prenatal hydronephrosis. It can be intrinsic, extrinsic due to crossing vessel (CV) or mixed. This paper aims to present the surgical outcome in a single pediatric thirdlevel center. Methods A retrospective analysis of all children operated between 2011 and 2018 was conducted. Demographic information, pre-operative pelvic antero-posterior diameter (APD), intra-operative parameters, hospital stay and follow-up were considered. Re-do operations and success rate for Vascular Hitch (VH), open and laparoscopic pyeloplasties were recorded. Results 128 patients were included. The mean pre-operative APD was 30 mm. The etiology was intrinsic in 71.9%, extrinsic in 25.0% and mixed in 3.1%. The median age between intrinsic and extrinsic groups was statistically different. Thirty-one VH, 88 dismembered and 9 non-dismembered pyeloplasties were performed. The median hospital stay was 2 days for VH and 6 for pyeloplasties. The median hospital stay was statistically longer in open pyeloplasties compared to laparoscopic. The mean post-operative APD was 14 mm. The success rate after VH was 90.3%, after open pyeloplasties 97.9% and after mini-invasive pyeloplasties 91.8%. Conclusions VH could be a good option in the treatment of hydronephrosis due to CV, laparoscopic pyeloplasties have equivalent success rate and shorter hospital stay than open pyeloplasties.

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“…Daher wurden verschiedene Verfahren beschrieben, durch die eine erhöhte Sicherheit für eine erfolgreiche Vascular-hitch-Prozedur erreicht werden könnte. Miranda et al schlugen vor, intraoperativ den ureteralen Öffnungsdruck durch eine perkutane Punktion des Nierenbeckens vor und nach der Gefäßverlagerung zu messen [18]. Parente et al kalibrierten den ureteropelvinen Übergang mit einem zystoskopisch eingebrachten Ballon und unter radiologischer Kontrolle bei 6 Patienten, um sicherer zwischen rein extrinsischer und assoziierter intrinsischer Stenose unterscheiden zu können [19].…”

Section: Introductionunclassified

Subpelvine Stenose & kreuzende Gefäße – Pro „vascular hitch“

2019

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ZusammenfassungDie Möglichkeit, eine durch aberrierende Unterpolgefäße bedingte subpelvine Stenose durch eine gefäßverlagernde Pyeloplastik (‚vascular hitch‘) zu behandeln, wird kontrovers diskutiert. Seit diese Technik bei Patienten mit aberrierenden Unterpolgefäßen minimal invasiv durchgeführt wird, mehren sich Publikationen mit kurz-, mittel- und langzeitiger Nachbeobachtung. Die Erfolgsraten werden hierbei analog zur Anderson-Hynes-Plastik mit > 90 % angegeben. Insgesamt scheint eine assoziierte intrinsische Stenose selten zu sein. Eine histologisch nachweisbare muskuläre Hypertrophie kann auch nur Hinweis auf eine Gegenregulation und zumindest bis zu einem gewissen Grad reversibel sein. Für die sicherere Differenzierung der Patienten, bei denen eine Gefäßverlagerung ausreichend ist, von den Patienten, die besser initial eine Anderson-Hynes-Pyeloplastik erhalten sollten, empfiehlt sich ein intraoperativer Diuresetest (Volumenbolus plus intravenöse Furosemidgabe). Eine assoziierte intrinsische Stenose erscheint bei trichterförmigem und ansonsten unauffällig aussehendem pyeloureteralen Übergang, abnehmender Hydronephrose nach Mobilisierung des Nierenbeckens und der aberrierenden Unterpolgefäße und einer effizienten Peristaltik über den pyeloureteralen Übergang während des intraoperativen Diuresetests unwahrscheinlich. Die Vascular-hitch-Technik ist weniger anspruchsvoll als die laparoskopische Anderson-Hynes-Plastik und geht daher mit kürzeren Operations- und Narkosezeiten einher. Weitere Vorteile sind: kein Risiko der Leckage oder späteren Anastomosenstenose und keine Notwendigkeit intraluminaler Stents. Die vascular hitch Operation stellt somit bei einem selektionierten Patientengut mit rein extrinsischer subpelviner Stenose eine scheinbar auch langfristig wirksame Alternative zur klassischen Anderson-Hynes-Plastik dar.

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Laparoscopic Transposition of Lower Pole Crossing Vessels (Vascular Hitch) in Children with Pelviureteric Junction Obstruction: How to Be Sure of the Success of the Procedure?

Cited by 19 publications

References 23 publications

Laparoscopic transposition of lower pole crossing vessels (vascular hitch) in children with pelviureteric junction obstruction

Laparoscopic transposition of lower pole crossing vessels (vascular hitch) in children with pelviureteric junction obstruction

Uretero-pelvic junction obstruction with and without crossing vessels: surgical outcome in a single center experience

Subpelvine Stenose & kreuzende Gefäße – Pro „vascular hitch“

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