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Pérez-Bertólez S, Martín-Solé O, García-Aparicio L. Comparison between mini-laparoscopy, conventional laparoscopy and open approach for ureteropelvic junction obstruction treatment in children. Scand J Urol 2021; 55:307-312. [PMID: 34227907 DOI: 10.1080/21681805.2021.1948098] [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: 10/20/2022]
Abstract
INTRODUCTION The aim of the study was to compare 3 mm mini-laparoscopy (mini LP), standard 5 mm laparoscopy (LP) and open surgery for pediatric pyeloplasty in a single center. METHODS Patients who underwent pyeloplasty from 1997 to 2017 at Hospital Sant Joan de Déu were prospectively collected. Demographic data, clinical, surgical and radiological variables were assessed. A multivariate logistic regression analysis was performed in order to identify risks for surgical complications, urinary leak and need for redo-surgery. RESULTS 340 pyeloplasties were performed in this period: 197 open, 30 LP and 113 mini LP. Independent risk factors for surgical complications in a multivariate logistic regression model were: LP (vs mini LP, OR = 3.95; 95% CI: 1.13-13.8), higher differential renal function (each point more increases the risk 6%; 95% CI: 1-11%), older children (every year increases the risk 1.11 times; 95% CI: 1.002-1.225). Open surgery, pelvis diameter or the use of different stents were not risk factors. This model had an 80% PPV and a 92% NPV. LP (OR = 4.65; 95% CI: 1.08-19.96) and longer surgical time (OR = 1.014; 95% CI: 1.003-1.025) were independent risk factors for urinary leak. Higher pelvis diameter (OR = 0.93; 95% CI: 0.87-0.99) and the use of external stents were independent protective risk factors for urinary leak (OR = 0.09; 95% CI: 0.01-0.72). We have not found independent risk factors for redo-surgery in a multivariate logistic regression model. CONCLUSION mini LP can be safely and effectively used to perform pyeloplasty in pediatric patients of all ages.
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Affiliation(s)
- Sonia Pérez-Bertólez
- Department of Pediatric Surgery, Pediatric Urology Unit, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Oriol Martín-Solé
- Department of Pediatric Surgery, Pediatric Urology Unit, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Luis García-Aparicio
- Department of Pediatric Surgery, Pediatric Urology Unit, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
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Sforza S, Grosso AA, Masieri L. Commentary: Early Robotic-Assisted Laparoscopic Pyeloplasty for Infants Under 3 Months With Severe Ureteropelvic Junction Obstruction. Front Pediatr 2021; 9:724219. [PMID: 34447732 PMCID: PMC8382953 DOI: 10.3389/fped.2021.724219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 07/02/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Simone Sforza
- Department of Pediatric Urology, Meyer Children Hospital, University of Florence, Florence, Italy
| | - Antonio Andrea Grosso
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Lorenzo Masieri
- Department of Pediatric Urology, Meyer Children Hospital, University of Florence, Florence, Italy
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Kong X, Li Z, Li M, Liu X, He D. Comparison of Drainage Methods After Pyeloplasty in Children: A 14-Year Study. Front Pediatr 2021; 9:779614. [PMID: 34966703 PMCID: PMC8710775 DOI: 10.3389/fped.2021.779614] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/11/2021] [Indexed: 11/30/2022] Open
Abstract
Objective: To summarize our experiences with drainage methods after laparoscopic pyeloplasty with a 14-year study. Methods: We reviewed the data of the 838 children operated on for hydronephrosis due to congenital ureteropelvic junction obstruction (UPJO) between July 2007 and July 2020. Patients' demographics, perioperative details, postoperative drainage stents [including double-J stent, percutaneous trans-anastomotic (PU) stent, and trans-uretero-cystic external urethral stent (TEUS)], complications, hospital stay, and long-term follow-up outcomes were analyzed. Long-term follow-up was performed by outpatient visits and telephone follow-up. Moreover, we reviewed the details of nine cases of recurrence after laparoscopic pyeloplasty. Results: Comparison of preoperative general data among the three groups indicated that there was no statistical difference in age, gender, and surgical side of the three groups. Statistical differences were found in the incidence of postoperative complications from the three postoperative drainage method groups, especially the incidence of reoperations (p < 0.01): there were six cases (3.19%) of recurrences in the TEUS group, two cases (0.36%) in the DJ group, and one case (0.93%) in the PU group. In the six recurrent cases from the TEUS group, four cases (44.4%) were found to have stenosis, and two cases (22.2%) have iatrogenic valvular formation. Conclusion: Not all three types of drainage methods are suitable for drainage after pyeloplasty. Based on our findings, TEUS is not recommended.
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Affiliation(s)
- Xiangpan Kong
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
| | - Zhenpeng Li
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
| | - Mujie Li
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
| | - Xing Liu
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
| | - Dawei He
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
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He Y, Song H, Liu P, Sun N, Tian J, Li M, Li N, Qu Y, Han W, Feng G, Ni X, Zhang W. Primary laparoscopic pyeloplasty in children: A single-center experience of 279 patients and analysis of possible factors affecting complications. J Pediatr Urol 2020; 16:331.e1-331.e11. [PMID: 32334969 DOI: 10.1016/j.jpurol.2020.03.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 03/31/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Laparoscopic pyeloplasty (LP) has been widely used in the treatment of pediatric ureteropelvic junction obstruction (UPJO). However, no prior reports with a large pediatric series have focused on the analysis of complications and impact factors of the outcomes. We hypothesized there were risk factors of higher Clavien grade postoperative complications. OBJECTIVE To analyze the characteristics of complications and risk factors of high Clavien grade postoperative complications. PATIENTS AND METHODS All children with UPJO treated with primary transperitoneal LP between July 2016 and July 2018 were retrospectively reviewed. The Clavien complication grades in groups with different weight, intraoperative complication (drainage methods), anteroposterior pelvic diameters (APPD), side, gender, title of surgeon, preoperative presentation and obstruction reason were compared. RESULTS Of the 279 children, intraoperative complications in which the placement of double-J stents was not accomplished and conversion to open surgery (Satava grade II) occurred in 17 (6.09%) and 2 (0.72%) patients, respectively. A total of 270 patients (277 kidneys) were included in the analysis of postoperative complications. Postoperative complications occurred in 51 (18.89%) patients. The most frequent postoperative incident was febrile UTI in 27 patients. Of the 13 patients who required reoperations, 6 patients had kidney restenosis and were considered as failure of surgery. All complications with an exact onset time occurred within 10 months after surgery. In the univariate and multivariate analysis, weight <10 kg and having intraoperative complication with nephrostomy tube were risk factors of higher Clavien postoperative complication grade (P<0.05). DISCUSSION Patients who were <10 kg in weight and having intraoperative complication with nephrostomy tube had a greater risk of a higher Clavien grade postoperative complication. To reduce high Clavien grade postoperative complications, asymptomatic patients under 10 kg in weight and having intraoperative complication with nephrostomy tube need close monitoring. In the 26 patients who had an exact time of the postoperative complications, the longest time we found was 10 months. Thus, we recommend the follow-up time required to observe postoperative complications in patients should be at least 10 months after surgery. CONCLUSIONS LP has been proven to be safe and effective in children with a low rate of complications. Weight <10 kg and having intraoperative complications with nephrostomy tube were risk factors of higher Clavien grade postoperative complications. Children with low weight and intraoperative complications need more attention in terms of the occurrence of complications.
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Affiliation(s)
- Yuzhu He
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Hongcheng Song
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Pei Liu
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Ning Sun
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Jun Tian
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Minglei Li
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Ning Li
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Yanchao Qu
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Wenwen Han
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Guoshuang Feng
- Center for Clinical Epidemiology & Evidence-Based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Xin Ni
- Department of Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
| | - Weiping Zhang
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
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Leonardo CR, Muzzi A, Tavora JE, Soares RQ. The outcomes of mini-laparoscopic pyeloplasty in children - brazilian experience. Int Braz J Urol 2020; 46:253-259. [PMID: 32022515 PMCID: PMC7025835 DOI: 10.1590/s1677-5538.ibju.2019.0381] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 08/30/2019] [Indexed: 11/23/2022] Open
Abstract
Objetive Pelvicureteric junction (PUJ) obstruction is the main cause of hydronephrosis in childhood. Open pyeloplasty has been the gold standard treatment of this condition with success rate above 90%. The role of laparoscopic pyeloplasty (LP) in children is less well defined and has slowly emerged as an alternative procedure. We report outcomes of our initial experience with LP in 38 children from 2 months of age. Materials and Methods From June 2015 to December 2017 38 children aged 2-60 months (mean age 1.7 years) underwent LP for correction of PUJ obstruction. The mean pre operative anteroposterior diameter of the renal pelvis (APD) was 43,5mm and all patients had hydronephrosis (APD 21.4-76 mm) and obstructed curve on diuretic renogram. Anderson-Hynes pyeloplasty was the performed technique. Results are reported. Results Mean operative time was 107 minutes (70-180) with no conversion to open procedure. Pain control was needed mainly in the first 12hs. Mean hospitalization was 2 days (1-5). There were complications in 5 children not affecting the final outcome. Two patients had a re-obstruction requiring a second procedure with good result. The mean follow up was 18 months (13-36). The mean reduction on the postoperative APD was 41% - p<0,001 (end APD 5 to 41mm). Overall success rate was 94,7%. All children had good cosmetic results. Conclusions This is a small series limited by short follow up, however its data suggest that LP has good functional and cosmetic results, not compromising the success of the open procedure, regardless patient age.
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Affiliation(s)
- Cristiane Reis Leonardo
- Departamento de Urologia Pediátrica, Neocentro - Hospital Vila da Serra, Nova Lima, MG, Brasil
| | - Alexandra Muzzi
- Departamento de Cirurgia Pediátrica, Neocentro - Hospital Vila da Serra, Nova Lima, MG, Brasil
| | - José Eduardo Tavora
- Departamento de Urologia, Neocentro - Hospital Vila da Serra, Nova Lima, MG, Brasil
| | - Rodrigo Q Soares
- Departamento de Urologia, Neocentro - Hospital Vila da Serra, Nova Lima, MG, Brasil
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Masieri L, Sforza S, Cini C, Escolino M, Grosso A, Esposito C, Minervini A, Carini M. Minilaparoscopic Versus Open Pyeloplasty in Children Less Than 1 Year. J Laparoendosc Adv Surg Tech A 2019; 29:970-975. [DOI: 10.1089/lap.2018.0586] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Lorenzo Masieri
- Paediatric Urology Unit, Meyer Children Hospital, University of Florence, Florence, Italy
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Simone Sforza
- Paediatric Urology Unit, Meyer Children Hospital, University of Florence, Florence, Italy
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Chiara Cini
- Paediatric Urology Unit, Meyer Children Hospital, University of Florence, Florence, Italy
| | - Maria Escolino
- Paediatric Surgery Unit, Federico II Hospital, University of Neaples, Naples, Italy
| | - Antonio Grosso
- Paediatric Urology Unit, Meyer Children Hospital, University of Florence, Florence, Italy
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Ciro Esposito
- Paediatric Surgery Unit, Federico II Hospital, University of Neaples, Naples, Italy
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Marco Carini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
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Simforoosh N, Ansari Djafari A, Shemshaki H, Shakiba B, Golshan A, Bonakdar M. Mini-Laparoscopic Management of Ureteropelvic Junction Obstruction in Adults and Children: A High-Volume Case Series. J Laparoendosc Adv Surg Tech A 2019; 29:747-751. [DOI: 10.1089/lap.2018.0470] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nasser Simforoosh
- Urology and Nephrology Research Center (UNRC), ShahidBeheshti University of Medical Sciences, Tehran, Iran
| | - Anahita Ansari Djafari
- Urology and Nephrology Research Center (UNRC), ShahidBeheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza Shemshaki
- Urology and Nephrology Research Center (UNRC), ShahidBeheshti University of Medical Sciences, Tehran, Iran
| | - Behnam Shakiba
- Urology and Nephrology Research Center (UNRC), ShahidBeheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Golshan
- Urology and Nephrology Research Center (UNRC), ShahidBeheshti University of Medical Sciences, Tehran, Iran
| | - Milad Bonakdar
- Urology and Nephrology Research Center (UNRC), ShahidBeheshti University of Medical Sciences, Tehran, Iran
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8
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Zamfir Snykers C, De Plaen E, Vermersch S, Lopez M, Khelif K, Luyckx S, Philippe P, Varlet F, Steyaert H. Is Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction in Infants Under 1 Year of Age a Good Option? Front Pediatr 2019; 7:352. [PMID: 31608264 PMCID: PMC6773808 DOI: 10.3389/fped.2019.00352] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 08/07/2019] [Indexed: 12/26/2022] Open
Abstract
Purpose: Laparoscopic pyeloplasty in children younger than 1 year of age is still debatable due to its supposed technical difficulties and failure rate. We present our experience and outcome in infants. Materials and Methods: A retrospective study was conducted in 3 Departments of Pediatric Surgery. We reviewed the records of the children under 1 year of age operated on for ureteropelvic junction obstruction (UPJO), between 2007 and 2017. Anderson-Hynes laparoscopic transabdominal dismembered pyeloplasty was performed. Patients' demographics, results of preoperative and postoperative exams, perioperative details, complications, hospital stay, and long-term follow-up results were analyzed. Results: Sixty cases were operated on during this period (49 boys, 11 girls). Mean age at operation was 4.5 months (1-12 months). Mean operating time was 140 min (80-240 min). There was no conversion in this group. There were four early complications: 1 ileus, 1 hypertension immediately post-operatively requiring medical treatment, 1 omental herniation through a drain orifice, and 1 percutaneous transanastomotic stent migrated intra-abdominally. The two last children had to be reoperated. Mean hospital stay was of 2 days (1-10 days). Late complications: two patients (3.4%) presented a recurrence of UPJO, one had been re-operated 15 months later and for the patient with persistent hypertension, nephropexy was performed for malrotated kidney, 1 year after pyeloplasty. Long term follow-up with a mean of 2.8 years (1-10 years) showed that surgery improved mean pelvic dilatation from 31.8 mm (13-63 mm) preoperatively to 15.3 mm (4-40 mm) postoperatively (P < 0.0001). The renal function slightly improved, from a mean of 35.7% (5-55%) it passed to 40.5% (0-54%), p = 0.137. In three cases the operated kidney became finally non-functional and atrophic. Conclusions: Laparoscopic transperitoneal pyeloplasty is feasible and safe in children younger than 1 year of age. Nevertheless, it requires experience and good intra-abdominal suturing skills. Laparoscopic pyeloplasty has a success rate comparable with open treatment but with less morbidity and better cosmetic results.
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Affiliation(s)
- Corina Zamfir Snykers
- Hôpital Universitaire Des Enfants Reine Fabiola, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Elea De Plaen
- Hôpital Universitaire Des Enfants Reine Fabiola, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Sophie Vermersch
- Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France
| | - Manuel Lopez
- Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France
| | - Karim Khelif
- Hôpital Universitaire Des Enfants Reine Fabiola, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Stephane Luyckx
- Hôpital Universitaire Des Enfants Reine Fabiola, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Paul Philippe
- Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Francois Varlet
- Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France
| | - Henri Steyaert
- Hôpital Universitaire Des Enfants Reine Fabiola, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Li K, Hu C, Huang W, Si-Tu J, Lu L, Mao Y, Zhang H, Qiu J, Wang D. A modification with threading cannula needle-assisted 4-point suspension fixation for retroperitoneal laparoscopic pyeloplasty in children with ureteropelvic junction obstruction: a cohort study in single center. Int Urol Nephrol 2018; 51:193-199. [PMID: 30519979 PMCID: PMC6394441 DOI: 10.1007/s11255-018-2048-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/03/2018] [Indexed: 12/25/2022]
Abstract
Purpose To evaluate the effect and safety of modifying a threading cannula needle-assisted suspension fixation in retroperitoneal laparoscopic dismembered pyeloplasty (LDP) for children with congenital ureteropelvic junction obstruction (UPJO). Methods Between December 2012 and December 2017, 45 children (< 14 years of age) with congenital UPJO were divided into two groups. In Group A, children underwent conventional “no-suspension fixation” LDP; and in Group B, “4-point suspension fixation” LDP was performed to lower difficulties and shorten operative time. The perioperative clinical data were recorded and analyzed. Results No statistical difference was found between two groups in preoperative characteristics. The duration of surgery, operative time for completion of anastomosis and the length of postoperative hospital stay in Group B was remarkably shortened than that in Group A, respectively (P < 0.05 for all). There was no significant difference between two groups in terms of postoperative renal pelvic diameter (RPD) decreasing, extubation time and success rates of surgery (P > 0.05 for all). In addition, no recurrent stenosis and urine leakage in both groups, and the postoperative RPD remained at the low level in both groups during the period of follow-up. Conclusions Our modification of the 4-point suspension fixation for retroperitoneal LDP is an effective and safe method for children with UPJO. It can simplify the surgical procedures, lower difficulties (especially in precise anastomotic suturing) and shorten the learning curve. This modification might be of particular interest to urologists for improving treatment of children with UPJO.
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Affiliation(s)
- Ke Li
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road 600, Guangzhou, 510630 Guangdong China
| | - Cheng Hu
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road 600, Guangzhou, 510630 Guangdong China
| | - Wentao Huang
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road 600, Guangzhou, 510630 Guangdong China
| | - Jie Si-Tu
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road 600, Guangzhou, 510630 Guangdong China
| | - Li Lu
- Department of Urology, The Sixth Affiliated Hospital of Sun Yat-sen University, Yuancun Erheng Road 26, Guangzhou, 510655 Guangdong China
| | - Yunhua Mao
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road 600, Guangzhou, 510630 Guangdong China
| | - Huimin Zhang
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road 600, Guangzhou, 510630 Guangdong China
| | - Jianguang Qiu
- Department of Urology, The Sixth Affiliated Hospital of Sun Yat-sen University, Yuancun Erheng Road 26, Guangzhou, 510655 Guangdong China
| | - Dejuan Wang
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road 600, Guangzhou, 510630 Guangdong China
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Bañuelos Marco B, Fuller TF, Friedersdorff F, González R, Lingnau A. Transperitoneal Mini-Laparoscopic Pyeloplasty in Flank Position: A Safe Method for Infants and Young Adults. Front Surg 2018; 5:32. [PMID: 29725594 PMCID: PMC5917372 DOI: 10.3389/fsurg.2018.00032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 04/03/2018] [Indexed: 12/29/2022] Open
Abstract
Introduction and Objectives Open dismembered pyeloplasty has been the gold standard treatment for ureteropelvic junction obstruction in children. Laparoscopic pyeloplasty (LP) is becoming a standard procedure, but its acceptance is slow. We report our method for minilaparoscopy (MLP) in children using a tansperitoneal approach with the patient in the lateral flank decubitus which we found technically advantageous. Materials and Methods Retrospective review of the records of 52 children and adolescents up to 18 years of age who underwent transperitoneal MLP at our institution during March 2012–October 2017 A 5 mm trocar is placed for the camera at the site of the umblicus by open technique, two 3 mm trocars placed in the upper and lower quadrants of the abdomen. No additional ports were necessary. 20cm long, 3-mm-diameter instruments are used. Few cases needed percutaneous fixation of the pelvis. The anastomosis is performed with 5–0 or 6–0 Polyglecaprone 25 (Monocryl®) with 13 mm half circle needle (TF plus) suture cut to 12–14 cm length and introduced through the 5-mm port. Needles are removed through the 3-mm port under direct vision. Results Fifty-two children (53 renal units) with a mean age of 82 months (range 3.5–204), a mean weight of 24,35 kg (range 7–57), and a mean follow-up of 20,44 months (6–60). Nine children were younger than 12 months, and 14 were ≤10kg. Six patients were >50kg. The mean of preoperative grade of dilatation was III (SFU scale) and postoperatively improved to SFU 0,60 (0–2). In 50 (94,3%) of the cases, there was complete resolution of hydronephrosis. There was no conversions to open surgery. Three patients suffered complications Clavien-Dindo Classification IIIb, 2 omental prolapses through a port site in two children which required general anaesthesia and one percutaneous drainage due to a leakage. No reinterventions related to stent complications or obstruction were found. Mean hospital stay was 4,69 (3–14) days. Conclusions The method of mini LP described here has proven efficient and safe. Weight appeared not to be limitation for both groups ≤10 and >50 kg.
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Affiliation(s)
| | | | | | | | - Anja Lingnau
- Urology, Charité Universitätsmedizin Berlin, Berlin, Germany
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