1
|
Tanash MA, Bollu BK, Naidoo R, Alexander A, Thomas G, Deshpande AV, Smith GH, Giutronich S. Laparoscopic versus open pyeloplasty in paediatric pelvi-ureteric junction obstruction. J Paediatr Child Health 2023; 59:974-978. [PMID: 37246761 DOI: 10.1111/jpc.16443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 05/13/2023] [Indexed: 05/30/2023]
Abstract
AIM Compared to open pyeloplasty (OP), we hypothesised that laparoscopic pyeloplasty (LP) is associated with early recovery, a shorter length of stay (LOS) and less analgesia requirement. METHODS Between 2011 and 2016, 146 dismembered pyeloplasty cases were reviewed, of which 113 were in the OP group and 33 were in the LP group. We evaluated both groups regarding operative time, LOS, success rate, complications rate and analgesia requirement. Subgroup analysis was done for patients above the age of 5 years, and within the OP group (dorsal lumbotomy (DL) vs. loin incision (LI)). RESULTS The success rate was 96% in the open group and 97% in the laparoscopic group. The median operative time was significantly shorter in the open group for the entire cohort (127 vs. 200 min; P < 0.05), and in children older than 5 years (n = 41, 134 vs. 225 min; P < 0.05). Other parameters were similar in both groups. The median LOS was significantly shorter (2 vs. 4 days; P < 0.05), and the median analgesia requirement was less (0.44 vs. 0.64 mg/kg morphine; P < 0.05) in the DL (n = 60) compared to LI (n = 53). CONCLUSION Both OP and LP dismembered approaches are equally effective in treating pelvi-ureteric junction obstruction. Overall, the LOS, complications rate and analgesia requirement were not significantly different; however, the operative time was significantly longer in LP.
Collapse
Affiliation(s)
- Mohammad A Tanash
- Paediatric Urology Unit, Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
- Division of Urology, Department of General Surgery, Jordan University of Science and Technology, Irbid, Jordan
| | - Bapesh K Bollu
- Paediatric Urology Unit, Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Rasika Naidoo
- Paediatric Urology Unit, Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Angus Alexander
- Paediatric Urology Unit, Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Gordon Thomas
- Paediatric Urology Unit, Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Aniruddh V Deshpande
- Paediatric Urology Unit, Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Grahame Hh Smith
- Paediatric Urology Unit, Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Sarah Giutronich
- Paediatric Urology Unit, Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| |
Collapse
|
2
|
Cooke I, Sadruddin S, Patil D, Tripathi S, Nabavizadeh R, Joshi S, Narayan V, Ogan K, Master VA. A Helpful Tool in the Renal Surgery Armamentarium: Dorsal Lumbotomy nephrectomy for Tumor in Patients with End-Stage Renal Disease. Urology 2021; 153:327-332. [PMID: 33774041 DOI: 10.1016/j.urology.2021.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 02/07/2021] [Accepted: 03/11/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare operative outcomes between the dorsal lumbotomy (DL) and laparoscopic nephrectomy (LN) approaches for patients with end stage renal disease (ESRD) undergoing nephrectomy. DL operative technique is also described. MATERIALS AND METHODS We performed a retrospective review of all patients undergoing DL nephrectomy at Emory University from 2008-2020. Cases were matched with control patients with ESRD who had undergone LN. Parameters evaluated included operative time, estimated blood loss, length of stay, postoperative narcotic requirements, and complication rates. Statistical analysis performed with SPSS. RESULTS 43 DL patients and 86 LN patients were assessed. DL had shorter total OR time (173min vs 198min; P = 0.001) and surgery time (101min vs 135min; P<0.001) compared to LN. There was a trend towards decreased mean length of stay among the DL group (2.65d vs 3.14d; P = 0.069) as well as daily narcotic requirement measured in oral morphine equivalents (54.8mg/day vs 73.6mg/day, P = 0.051). There were no differences in estimated blood loss, perioperative complication rates, ICU admissions, or 30-day readmissions. Limitations include retrospective design and small sample size. CONCLUSION Among patients with ESRD, DL was found to be safe and effective compared to LN, with shorter operative times, a trend towards decreased length of stay and post-operative narcotic requirements, and similar perioperative complication rates. DL should be considered as an approach for nephrectomy in this patient population.
Collapse
Affiliation(s)
- Ian Cooke
- Department of Urology, Emory University, Atlanta, GA
| | | | | | | | | | - Shreyas Joshi
- Department of Urology, Emory University, Atlanta, GA
| | | | - Kenneth Ogan
- Department of Urology, Emory University, Atlanta, GA
| | - Viraj A Master
- Department of Urology, Emory University, Atlanta, GA; Winship Cancer Institute, Emory University, Atlanta, GA.
| |
Collapse
|
3
|
Alhindi S, Mubarak M, Alaradi H. Evaluation of transverse dorsal lumbotomy in management of PUJ obstruction in patients younger than 6 months. Urologia 2021; 89:285-291. [PMID: 33586635 DOI: 10.1177/0391560321993600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The transverse dorsal lumbotomy approach provides excellent exposure to the PUJ and causes minimal tissue damage. In this study, we assess the efficacy of dorsal lumbotomy in PUJ obstruction in children younger than 6 months. METHODS All children less than 6 months who were managed with the dorsal lumbotomy approach between 2009 and 2017 were reviewed prospectively. Data included: demographic data, pre/post-operative renal ultrasound scan with SFU grading and RDS, operative time, post-operative complications, and follow up results. RESULTS A total of 42 children with a mean age of 4.4 ± 1 months were included. On pre-operative RDS, all patients had an obstructive pattern and a SRF of 30.3 ± 9.3. The mean operative duration was 49 min and analgesia was minimal. Post-operative ultrasound at 6 months showed an improvement in hydronephrosis (p < 0.05) and a mean SRF of 39.3 ± 6.1 (p < 0.001). CONCLUSION Transverse dorsal lumbotomy approach is a safe and efficient alternative in patients less than 6 month.
Collapse
Affiliation(s)
- Saeed Alhindi
- Department of Surgery, Salmaniya Medical Complex, Manama, Kingdom of Bahrain
| | - Mohamed Mubarak
- Department of Surgery, Salmaniya Medical Complex, Manama, Kingdom of Bahrain
| | - Husain Alaradi
- Department of Surgery, Salmaniya Medical Complex, Manama, Kingdom of Bahrain
| |
Collapse
|
4
|
Ismail A, Oquendo F, Allard-Ihala E, Elmansy H, Shahrour W, Prowse O, Kotb A. Transverse Lumbotomy for Open Partial/Radical Nephrectomy: How I Do It. Urol Int 2019; 104:131-134. [PMID: 31825948 DOI: 10.1159/000504787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 11/13/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Conventional open surgical techniques allow proper surgical management for renal malignancies but have their intrinsic drawbacks. The aim of this paper is to present our technique in minimal renal exposure while avoiding the intrinsic complications of conventional techniques. METHODS We described our technique, which can be easily understood and replicated by urologists performing open kidney surgery. RESULTS Ninety-five patients had this technique done safely over the last 4 years, and 3 patients had this exposure changed into intraperitoneal extended wound for very large upper pole tumours. The median operating time was 70 min. No single patient required intraoperative blood transfusion. Median warm ischemic time was 9 min. CONCLUSION Transverse lumbotomy is a safe reproducible technique that allows proper kidney exposure through a relatively smaller wound and avoiding unnecessary auxiliary techniques as rib resection, pleural tear management, and intraperitoneal exposure.
Collapse
Affiliation(s)
- Asmaa Ismail
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Fabiola Oquendo
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Erika Allard-Ihala
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Hazem Elmansy
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Walid Shahrour
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Owen Prowse
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Ahmed Kotb
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada,
| |
Collapse
|
5
|
Polok M, Apoznański W. Anderson-Hynes pyeloplasty in children - long-term outcomes, how long follow up is necessary? Cent European J Urol 2017; 70:434-438. [PMID: 29410899 PMCID: PMC5791399 DOI: 10.5173/ceju.2017.1431] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 08/20/2017] [Accepted: 09/01/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction Pyeloplasty is commonly conducted in children with uretero-pelvic junction obstruction. Standard post-operational procedure involves only a short period of time after the surgery. What is the real number of complications, including those in the long-term? What is the function of the operated kidney? The aims of this study are to assess the effectiveness of pyeloplasty and to assess the suitability of conducting long term follow-up after pyeloplasty. Material and methods 35 of 137 patients after open pyeloplasty between 1992–2006 responded to the invitation and returned for a control appointment. The median age was 8 years (range 1 month – 19 years). In 26 kidney units the disease proceeded with symptoms and in 10 cases it proceeded without symptoms. The predominant symptom was abdominal pain (n = 21). In each child both the control ultrasound and the diuretic renal scintigraphy of the kidneys were conducted. Results Regression of symptoms after the operation was obtained in 19 kidney units (73%). Improvement in scintigraphy was observed in 23 kidney units (82.1%), improvement in ultrasound was obtained in 32 (91%) kidney units. Complications which required surgical intervention occurred in 4 (11.1%) patients. One patient required operative removal of a pyelostomy tube, 2 patients (11.1%) required repeated pyleoplasty (23 and 27 months after the operation), one child required nephrectomy due to nephrogenic arterial hypertension (after 4 years). Conclusions Statistically, there are improvements of scintigraphic function of the kidney, improvements in ultrasound examinations, and the remission of symptoms after pyeoplasty. Most complications occur within 2 years after the surgery. Long-term follow up should be continued.
Collapse
Affiliation(s)
- Marcin Polok
- Department of Pediatric Surgery and Urology, Medical University of Wrocław, Wrocław, Poland
| | - Wojciech Apoznański
- Department of Pediatric Surgery and Urology, Medical University of Wrocław, Wrocław, Poland
| |
Collapse
|
6
|
Uguz A, Unsal M, Unalp O, Sezer T, Celtik A, Sozbilen M, Toz H, Hoscoskun C. Is a High Body Mass Index Still a Risk Factor for Complications of Donor Nephrectomy? Transplant Proc 2015; 47:1291-3. [DOI: 10.1016/j.transproceed.2015.04.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
7
|
Does the surgical approach change the need for a retrograde pyelogram prior to pyeloplasty? J Pediatr Urol 2014; 10:835-9. [PMID: 24690464 DOI: 10.1016/j.jpurol.2014.01.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 01/29/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The opinion on the use of retrograde ureteropyelography (RUPG) prior to routine pyeloplasty for an ureteropelvic (UPJ) obstruction has been divided. This study analyses the efficacy of a preoperative RUPG and determines if a dorsal lumbotomy (DL) approach offers any advantage in this situation. METHODS This is a retrospective analysis of application of RUPG prior to pyeloplasty in children with ages ranging from 42 days to 16.2 years who underwent surgery at the Children's Hospital at Westmead between 2009 and 2013. RESULTS We identified a total of 95 children with isolated UPJ obstruction, with 59 (62.1%) boys and 36 (37.8%) girls. Overall, open pyeloplasties were performed in 89 (42 DL: 47 loin incision) and the rest (n = 6) laparoscopically. Preoperative RUPG was performed in 58 (61%) and it provided additional information in 11 (18.9%) patients for whom the surgical approach was modified. Hospital stay, operative time, and time to full diet were shorter with the DL approach (p < 0.05). CONCLUSIONS The current study suggests that RUPG is avoidable if the approach for pyeloplasty is through the conventional loin incision. The short-term advantages might rationalize the use of RUPG if a DL incision is employed.
Collapse
|
8
|
Samarasekera D, Kim DSH, Wang R, Yip G, Tang SS, Nguan C. Laparoscopy, dorsal lumbotomy and flank incision live donor nephrectomy: comparison of donor outcomes. Can Urol Assoc J 2013; 7:E69-73. [PMID: 23671511 DOI: 10.5489/cuaj.266] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
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.
Collapse
Affiliation(s)
- Dinesh Samarasekera
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC
| | | | | | | | | | | |
Collapse
|
9
|
Sahin C, Kalkan M, Uzun H. Minimal invasive pyeloplasty technique with vertical surgical approach: an alternative to laparoscopic pyeloplasty. Kaohsiung J Med Sci 2012; 28:100-4. [PMID: 22313537 DOI: 10.1016/j.kjms.2011.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 03/24/2011] [Indexed: 11/30/2022] Open
Abstract
This retrospective clinical study presents pyeloplasty results following a muscle-splitting dissection, with mini-flank incision, using instruments held in a vertical position. Between 2004 and 2010, dismembered pyeloplasty (Anderson-Hynes) was performed in 37 cases (32 males and 5 females) with an average age of 26 years (range, 20-56 years). The technique was carried out through a window opened by separating the lateral abdominal muscles. Operation duration, length of incision, postoperative pain, complications, and radiological and clinical results were discussed. The operation duration was between 50 and 90 minutes (average=65 minutes), the incisional length 5 and 7 cm (average=5.2 cm), and visual pain scale was 4.1 ± 3.1 and 3.3 ± 3.4 at 4 and 24 hours after the operation, respectively. The duration of hospitalization was between 30 and 120 hours (average=42 hours). In a retrospective analysis of our study, one case was reoperated on, following recurrence with obstruction, there were 9 cases with prolonged dilation in response to diuretics and 29 cases with complete recovery. Pyeloplasty operations, with a vertical surgical approach through smaller incisions and muscle separation, offered shorter periods of hospitalization, less postoperative pain, acceptable cosmetic results and higher rates of functional recovery.
Collapse
Affiliation(s)
- Coşkun Sahin
- Sema Hospital, Department of Urology, Istanbul, Turkey
| | | | | |
Collapse
|
10
|
Kajbafzadeh AM, Tourchi A, Nezami BG, Khakpour M, Mousavian AA, Talab SS. Miniature pyeloplasty as a minimally invasive surgery with less than 1 day admission in infants. J Pediatr Urol 2011; 7:283-8. [PMID: 21527237 DOI: 10.1016/j.jpurol.2011.02.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Open dismembered pyeloplasty is usually performed through flank, anterior subcostal or posterior lumbotomy incisions. These incisions are cosmetically less acceptable and may produce significant postoperative pain. We present the smallest incision for open pyeloplasty, called a 'miniature pyeloplasty'. The aim of this study was to reduce hospital stay and postoperative pain, along with enhanced cosmetic results. PATIENTS AND METHOD 373 infants (mean age 4 months) with hugely dilated pelvises underwent the miniature pyeloplasty. The exact site of incision was determined by intraoperative renal ultrasonography and palpation. A muscle-splitting incision was made in the most dependent part of the lower quadrant. After meticulous dissection of the ureteropelvic junction component, the affected section was pulled out and underwent classic dismembered pyeloplasty without renal pelvis reduction. All children had long-duration stented anastomoses. Surgical incision size, operative time, hospital stay, postoperative analgesic use and complication rate were recorded. RESULTS The operation was successful in all patients. The mean operative time was 53 min (range 43-75) and patients were discharged after 18 ± 3 (mean ± SD) h. Incision size ranged from 11 to 15 mm (mean 13). No narcotic analgesic was required postoperatively and there were no major complications during follow up. CONCLUSIONS Miniature pyeloplasty is a safe and successful technique for ureteropelvic junction obstruction that avoids long operative time with negligible postoperative pain compared to the classic open pyeloplasty in infants. The exact incision site must be reconfirmed intraoperatively by physical examination or renal ultrasonography.
Collapse
Affiliation(s)
- Abdol-Mohammad Kajbafzadeh
- Pediatric Urology Research Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran.
| | | | | | | | | | | |
Collapse
|