Comparison of Flank, Dorsal Lumbotomy and Laparoscopic Approaches for Dismembered Pyeloplasty in Children Older Than 3 Years With Ureteropelvic Junction Obstruction

Braga, Luis H.; Lorenzo, Armando J.; Bägli, Darius; Mahdi, Mohamed; Salle, João L. Pippi; Khoury, Antoine E.; Farhat, Walid A.

doi:10.1016/j.juro.2009.09.008

Cited by 52 publications

(42 citation statements)

References 20 publications

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“…Braga and colleagues examined open flank, DL and laparoscopic procedures to treat ureteropelvic junction obstruction; they also observed that the laparoscopic approach had the longest operative time, but the shortest hospital stay, which is similar to our results. 3 With ongoing increased adoption of LDN, it is likely that LDN operative times will be reduced, and approach that of its open counterparts. 3 Patients in the LDN group lost a significantly lower amount of blood intraoperatively, experienced a lower rate of major and minor complications and spent less time in hospital postoperatively than patients in either the FL or DL groups.…”

Section: Discussionmentioning

confidence: 99%

“…2 Another approach that has been previously advocated for radical nephrectomy, renal stone and pyeloplasty procedures is the dorsal lumbotomy (DL). 3 It has a key advantage over the standard flank incision (FL) in that no muscles are transected, rather a muscle-splitting approach is used. 3 As a result, DL closures are quicker, stronger and result in less postoperative morbidity.…”

Section: Introductionmentioning

confidence: 99%

“…3 It has a key advantage over the standard flank incision (FL) in that no muscles are transected, rather a muscle-splitting approach is used. 3 As a result, DL closures are quicker, stronger and result in less postoperative morbidity. 3 In 1995, the first laparoscopic living donor nephrectomy (LDN) was performed; 4 since then, the technique has become increasingly popular due to its documented safety profile and reduced postoperative morbidity.…”

Section: Introductionmentioning

confidence: 99%

“…3 As a result, DL closures are quicker, stronger and result in less postoperative morbidity. 3 In 1995, the first laparoscopic living donor nephrectomy (LDN) was performed; 4 since then, the technique has become increasingly popular due to its documented safety profile and reduced postoperative morbidity. Specific benefits include decreased postoperative recovery time, a faster return to full activity, improved cosmesis and less postoperative pain.…”

Section: Introductionmentioning

confidence: 99%

“…3 It has a key advantage over the standard flank incision (FL) in that no muscles are transected, rather a muscle-splitting approach is used. 3 …”

mentioning

confidence: 99%

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Laparoscopy, dorsal lumbotomy and flank incision live donor nephrectomy: comparison of donor outcomes

Samarasekera

Kim

Wang

et al. 2013

CUAJ

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Background: Flank incision (FL), dorsal lumbotomy (DL) and laparoscopic surgery have been effective approaches to donor nephrectomy. While laparoscopic donor nephrectomy (LDN) has become increasingly popular, there has yet to be a direct comparison of the three modalities. Methods: We performed a retrospective chart review of FL, DL and LDN operations between 2002 and 2010 within a single institution. Donor and recipient characteristics, as well as surgical outcomes, were assessed. Results: There were 496 donor nephrectomy operations available for analyses. Patients in the LDN group had the lowest estimated blood loss, compared to the DL and FL groups (p < 0.001), lowest rate of complications (p < 0.01), and shortest hospital stay (p < 0.0001). Donors who underwent DL used an average of 60.12 ± 5.0 mg of morphine, which was significantly less than that used by patients in the LDN (93.2 mg, p < 0.0001) and FL (111.82 mg, p < 0.001) groups. Mean serum creatinine of recipients at day 1 post-op was the highest in the FL group (p < 0.0001 FL vs. LDN, p < 0.001 FL vs. DL), but there were no significant differences between the three groups at 2 weeks, 6, 12, 18, and 24 months post-operation (p > 0.45). Conclusions: Although a lower pain experience of LDN was not indicated, the use of LDN should be favoured over DL and FL as it is associated with fewer complications, and shorter length of stay. Of note, DL appears to be associated with higher complications and is likely not a preferred option for donor nephrectomy. RésuméContexte : L'incision du flanc, la lombotomie dorsale et la laparoscopie sont des techniques efficaces pour une néphrectomie chez un donneur vivant. Même si la laparoscopie a connu une montée en popularité, aucune comparaison directe entre les trois modalités n'a été effectuée. Méthodologie : Nous avons procédé à un examen rétrospectif des dossiers de patients ayant subi une néphrectomie par incision du flanc, par lombotomie dorsale et par laparoscopie entre 2002 et 2010 dans un même établissement. Les caractéristiques des donneurs et des receveurs ainsi que les résultats de la chirurgie ont été évalués. Résultats : Les analyses ont porté sur 496 néphrectomies. En comparaison avec les donneurs ayant subi une incision du flanc ou une lombotomie dorsale, les donneurs ayant subi une laparoscopie présentaient la perte sanguine estimée la plus faible (p < 0,001), le taux le plus bas de complications (p < 0,01) et la plus courte durée du séjour en hôpital (p < 0,0001). Les donneurs qui ont subi une lombotomie dorsale ont utilisé en moyenne 60,12 ± 5,0 mg de morphine, soit une valeur significativement plus faible que celle notée chez les patients ayant subi une laparoscopie (93,2 mg, p < 0,0001) et une incision du flanc (111,82 mg, p < 0,001). Le taux moyen de créatinine sérique le lendemain de l'intervention était le plus élevé chez les patients ayant subi une incision du flanc (p < 0,0001 incision du flanc vs laparoscopie, p < 0,001 incision du flanc vs lombotomie dorsale), mais les différences entre...

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Section: Discussionmentioning

confidence: 99%