Study comparing the applicability of dorsal lumbotomy in older children

Abstract

Objective: Dismembered pyeloplasty through dorsal lumbotomy to correct ureteropelvic junction obstruction is mainly successfully performed in children under 5 years old for technical reasons. We compared children who underwent dorsal lumbotomy by age group (<5 vs. ≥5 years old) to determine if the surgical success and long-term results were comparable. Materials and Methods:We retrospectively reviewed the charts of 134 children undergoing a pyeloplasty. Group 1 consisted of children <5 years old (n = 90) and Group 2 consisted of children ≥5 years old. Patients' characteristics, as well as hospital stay, narcotic use, radiologic follow-up and success rate, were compared. Success was defined by absence of symptoms and ≥50% reduction in renal pelvis anteroposterior diameter and/or scintigraphic normalization of the drainage T1/2 when obtained. Univariate analysis was performed to compare the groups. Results: Mean age (years) and weight (kg) at surgery for Groups 1 and 2 were 1/8 kg and 11/35 kg, respectively. Mean operative time was 98 minutes versus 120 minutes, respectively; mean hospital stay was 2.5 days for both groups and analgesia requirement was 50% higher in Group 2. A Pippi-Salle stent was used in 90% (n = 120) of cases. Mean follow-up was 26 months and the success rate was 89% and 90% for Groups 1 and 2, respectively. Conclusion: Our study showed comparable success rates. We can infer that, as a technique, dismembered pyeloplasty is effective and safe in the younger and older children.

Comparative Study Between Anderson-Hynes Pyeloplasty Through Transperitoneal Laparoscopic Approach Versus Vertical Lumbotomy Approach in UPJO Repair

“…The study concluded that dismembered pyeloplasty is effective and safe in the young and older children. [18] A study with 59 children with median age 5.7 years who underwent transverse dorsal lumbotomy. Median time was 78 minutes and median length of incision was 3-5 cm.…”

Response to “Evaluation of transverse dorsal lumbotomy in management of PUJ obstruction in patients younger than 6 months”

“…Some authors defend selecting the cases in which dorsal lumbotomy can be applied, not being useful in obese children. 2 What is missing in the work we are commenting on is the way in which the authors handle the polar vessels through this dorsal access. One of the basic principles of dismembered pyeloplasty is the transposition of the crossing vessels.…”

Dorsal Lumbotomy Approach for Pediatric Dismembered Pyeloplasty

“…Ureteropelvic junction obstruction (UPJO) is the most common cause of HDN in children. The choice of surgery is dismembered pyeloplasty that can be done by anterior subcostal, flank approach or dorsal lumbotomy approach [1,2]. The posterior vertical lumbotomy incision provides an easy and quick access to UPJ.…”