Ureteropelvic junction obstruction in children by polar vessels. Is laparoscopic vascular hitching procedure a good solution? Single center experience on 35 consecutive patients

Chiarenza, Salvatore Fabio; Bleve, Cosimo; Fasoli, Lorella; Battaglino, F; Bucci, Valeria; Novek, Steven J.; Zolpi, Elisa

doi:10.1016/j.jpedsurg.2015.10.005

Cited by 34 publications

(33 citation statements)

References 11 publications

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“…The Hellstrom method, also known as the vascular hitch procedure, has been abandoned for decades, but has been rediscovered thanks to the increasing popularity of laparoscopic approaches. Chiarenza et al presented their results, with an almost 100% success rate, and Madec et al achieved similar outcomes [19,20]. In our cohort, the success rate of the Fenger procedure was 75% in G1 and 100% in G2, and for the Hellstrom method it was 50% and 100%, respectively.…”

Section: Discussionsupporting

confidence: 72%

Learning curve or experience-related outcome: what really matters in paediatric laparoscopic pyeloplasty.

Panek¹,

Szmer²,

Kuijper³

et al. 2019

Videosurgery and Other Miniinvasive Techniques

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Introduction: The process of improving one's skills over time is called a "learning curve". This term has attracted great attention during the last decades, especially in relation to laparoscopic techniques. Aim: To assess the outcome of paediatric laparoscopic pyeloplasty (LP). Material and methods: Retrospective analysis of the consecutive LPs. The inclusion criteria: (1) children aged < 18 years, (2) transperitoneal approach, and (3) the same operating paediatric urologist (RC). Patients with a history of any procedure on the upper urinary tract were excluded. Any surgical reintervention during follow-up was defined as a failure. The outcomes of LPs performed before 2012 (G1) were compared to those conducted between 2012 and 2016 (G2). Fisher's exact test was used for statistical analysis. Results: Ninety patients met the inclusion criteria, and a total of 95 LPs were performed. The mean operation time was 155 min, and the mean hospitalisation period was 2.4 days. In G1, 19 patients underwent Anderson-Hynes LP, 16 had Fenger non-dismembered LP and two underwent vascular hitch. In G2, 54, 2 and 2 patients underwent these procedures, respectively. The overall success rate was 91.5%. There were six failures in G1 and three in G2 (p = 0.147). Of the Anderson-Hynes LPs, 1/19 in G1 and 3/58 in G2 required reintervention (p = 1). For Fenger LPs, this was 4/16 and 0/2, respectively (p = 1). Only one patient required reoperation after vascular hitch. Conclusions: The surgeons' learning curve reflects their experience with regard to the entire therapeutic process, but not exclusively their manual skills.

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Section: Discussionsupporting

confidence: 72%

Learning curve or experience-related outcome: what really matters in paediatric laparoscopic pyeloplasty.

Panek¹,

Szmer²,

Kuijper³

et al. 2019

Videosurgery and Other Miniinvasive Techniques

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“…We reviewed the literature and found few published series of laparoscopic relocation of lower pole CV in children with intermittent UPJO. The most recent series is reported by Schneider (8) (successful in up to 95% of patients), and Chiarenza-Bleve (17), (successful in 97% of patients), provided a careful selection of candidates. Meng and Stoller (in 2003) were the first authors reporting vascular relocation using the Hellstrom technique via laparoscopic approach.…”

Section: Discussionmentioning

confidence: 99%

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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“…Zu bedenken ist, dass in einem Viertel der Fälle neben dem extrinsischen auch ein intrinsisches Problem vorliegt, so dass chirurgisch der kontinuitätsdurchtrennenden Nierenbeckenplastik der Vorzug zu gegeben ist [42]. Wird eine alleinige extrinsische Obst ruktion durch ein unteres Polgefäß vermutet, kann neben der Nierenbeckenplastik nach Anderson-Heynes alternativ eine Vascular Hitch Operation modifiziert nach Hellström mit intraoperativer Abflusskontrolle zum Ausschluss eines intrinsischen Problems durchgeführt werden [43,44].…”

Section: Die Dekompensierte Oder Intermittierende Nierenbeckenabgangsunclassified

Akute Flankenschmerzen im Kindes- und Jugendalter

Ebert¹

2017

Aktuel Urol

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Ureteropelvic junction obstruction in children by polar vessels. Is laparoscopic vascular hitching procedure a good solution? Single center experience on 35 consecutive patients

Cited by 34 publications

References 11 publications

Learning curve or experience-related outcome: what really matters in paediatric laparoscopic pyeloplasty.

Learning curve or experience-related outcome: what really matters in paediatric laparoscopic pyeloplasty.

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

Akute Flankenschmerzen im Kindes- und Jugendalter

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