Endosurgery for the treatment of pyeloureteral obstruction in children

Rudin Yu.E., Maruhnenko D.V., Arustamov L.D., Lagutin G.V.

Introduction. Minimally invasive surgery is being widely implemented in the pediatric practices. The aim of our study was to evaluate the potential of the laparoscopic pyeloplasty in children.

Materials and methods. One hundred and twelve children were operated from 2006 to 2014 in the pediatric uroandrological department of National Scientific Institute of Urology in the age from 9 months up to 16 years (mean age 3.41 years). In 50 patients open pyeloplasty (OPP) was carried out (group I), in 62 patients – laparoscopic (LPP). Groups were similar in terms of age and hydronephrosis grade. Anderson-Hynes method was used for the reconstruction.

Results.The operation time for LPP was 90-312 min (157 minutes in average). Time for anastomosis was 40-60 min. Within the time, necessary for experience acquisition by the surgeon, time of LPP was decreased twice. Hospitalization duration fell with the introduction of LPP from 17.2 down to 7.5 days. Complications of the surgery were evident in 9 / 112 patients (8%). Four patients in Group I (8%) were repeatedly operated due to re-stricture. One conversion (1.6%) was done in Group II, two patients received the percutaneous nephrostomy tube due to the urinome (3.2%), and in 2 patients endopyelothomy was carried out due to re-stricture (3.2%). In one of Group II patients nephrectomy was done due to further deterioration of renal function despite of good urine passage. All re-operations were successful.

At the follow-up (in 4-6 months after operation) contraction of the pelvis was evident in 46 patients (92%) of Group I and in 59 patients (95.1%) in Group II, which outline the good outcomes.

Conclusions. The outcomes of the LPP are comparable with those of OPP. At that, some advantages could be stated for the LPP: decreased traumatization, quick recovery after operation, reduced time on-board and good esthetic results. Given the surgeon has enough experience, LPP could be used also in newborns. The ex vivo training at the laparoscopic simulator allows the elaboration of necessary skills and reduction of the operation time.

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