Functional Results of Laparoscopic Pyeloplasty in Children: Single Institute Experience in Long Term

Abstract

Objective: The aim of this study was to evaluate the long-term functional outcomes of laparoscopic pyeloplasty (LP) in children for consecutive cases of single institute. Materials and Methods: Our laparoscopy database was investigated for children in terms of LP between June 2008 and April 2015. All the patients had ureteropelvic junction obstruction (UPJO) and LP was performed. Demographic data including age, gender, side of UPJO, operation time, estimated blood loss (EBL), hospital stay and complications according to Clavien classifications were recorded. Renal ultrasonography and diethylenetriamine penta-acetate (DTPA) scintigraphies were respectively performed 3, 12 and 24 months after surgery. Statistical analyses were performed and p value was accepted as significant at <0.05. Result: Mean follow-up was 34 ± 4.7 months. The mean age was 13 (6-72) months. A total of 153 (110 boys and 43 girls) LP patients enrolled. Of that, 93 (60.78%) LP were in left side and 60 (39.21%) were in right side. Three cases needed open conversation according to difficulties in anastomosis. Aberrant crossing vessel was observed in 12 (7.84%) patients. The mean operation time was 155 ± 21 min and the mean EBL was 22 ± 11.1 ml. The mean hospital stay was 3.4 days. Anastomotic leakage was the common complication (in 13 patients) that was successfully managed conservatively (Clavien 1). Eight patients experienced unsuccessful LP and underwent open pyeloplasty (Clavien 3b). The mean split renal function significantly increased in DTPA scintigraphy in follow-up. The overall success was 91%. Conclusions: The LP procedure can be an effective and safe surgical method for childhood UPJO, specifically in the experienced hands of pioneer centers.

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

“…Although most series report longer operative time in LP, (mean 155-240min) (3,8,11,16) we had spent a mean of 107min., which may be near the open procedures time. Previous adult experience, same team, routine and focusing on simplifying every step certainly play a role in the operative time.…”

“…The dismembered LP for treatment of PUJ obstruction in children was first described in 1995 (5). 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. In fact it requires suture training and an experienced laparoscopist (3,8). There is a learning curve to LP with is far more difficult to pediatric surgeons.…”

“…A guide wire is placed through a 3mm aspirating tube in an antegrade fashion, saving the cystoscopy time. Those who favor cystoscopy insertion affirm that retrograde DJ insertion avoids stent dislodgement and related complications (8). However, a study of 15 academic European institutions showed that the antegrade fashion provided the lowest complication rate compared with retrograde stent insertion (17).…”

“…Although we had a small omental prolapse, it wasn't necessary any surgical procedure to deal with. Adequate size Blake® drains may reduce the reported risk (8).…”