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Laparoscopic Pyeloplasty In Children: Long-Term Outcome

September 08, 2017

UroToday - This study by Dr. M.S. Ansari, et al. assessed the safety and efficacy of laparoscopic pyeloplasty in a pediatric population. It prospectively analyzed 53 patients who underwent laparoscopic pyeloplasty. The mean age of the patients was 9.12 years and the group was comprised of a male to female ratio of 4.3:1.

Dismembered pyeloplasties were performed in 41 patients and a Foley Y-V plasty in the other 12 patients via transperitoneal approach. Three ports were used in 50 of the children and four ports in the other three. The mean operative time was 181 minutes. The mean blood loss was 118 cc. The mean hospital stay was five days. Conversion to open surgery was ultimately required in four patients.

Follow-up renography, available in 49 patients, showed improvement in drainage in 44 patients and an obstructed pattern in five. Of these five, two patients had significant deterioration in split function. These two patients underwent redo pyeloplasty by an open technique while the other three who had an obstructed patterns elected conservative approaches. The mean follow-up occurred at 24.5 months, and reflected an overall success rate of 89.7%. The group concluded that laparoscopic pyeloplasty to correct a UPJ obstruction is safe and effective as a minimally invasive modality. They felt they had a good intermediate term success rate with a minimal amount of morbidity.

It would be interesting to know if these five patients were operated on extremely early in their learning curve or if the procedures were performed later on. It would also be interesting to truly see how long the stents were placed in these selected patients and if there were any differences between the times the stents were placed and the times of removal.

I feel that both in the adult and pediatric populations, laparoscopic pyeloplasty has slowly approached the success rate of open surgery and should be considered as one of the gold standards of repair. However, doctors should be judicious in how they implement laparoscopy in their practice as the learning curve is quite steep. There should be some adherence to dry labs and porcine models to facilitate learning and mastery of intracoporeal suturing, which is the right limiting step for this procedure.

Ansari MS, Mandhani A, Singh P, Srivastava A, Kumar A, Kapoor R
Int J Urol. 2008 Sep 2. (Epub ahead of print.)

UroToday Medical Editor Pasquale Casale, MD

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