Reoperative Laparoscopic Pyeloplasty In Children: Comparison With Open Surgery

Main Category: Urology / Nephrology
Also Included In: Pediatrics / Children's Health
Article Date: 26 Aug 2007 - 0:00 PST

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UroToday.com- A study by Piaggio, et al assessed the feasibility of pediatric redo laparoscopic pyeloplasty in comparison in regards to safety, efficacy, operative time, blood loss, postoperative analgesic requirements, length of hospitalization, complications, need for readmission, and subsequent procedures. This was a retrospective chart review of 10 consecutive patients who underwent re operative pyeloplasty in a 3 year period.

A total of 10 patients (11 redo pyeloplasties) were divided into 2 groups. Four underwent open redo pyeloplasties and 6 underwent laparoscopic redo pyeloplasties. The groups were similar in age, sex, weight, laterality, number, and type of prior interventions to repair the ureteropelvic junction obstruction. The laparoscopic procedure took longer in the operating room than the open procedure. The success rates were similar between both groups at approximately 80%. The redo laparoscopic group had a shorter length of stay when compared to the open group as well as a decreased use of narcotics. There were also fewer complications in the laparoscopic group.

The group concluded that redo laparoscopic pyeloplasty in the pediatric population is feasible. They commented that in experienced hands pediatric redo laparoscopic pyeloplasty can be performed safely with a success rate similar to that of open surgery. They also claim it may provide a faster recovery with decreased analgesic requirements.

There was an editorial comment by Dr. Fernando J. Kim, Chief of Urology in Denver, CO who stated that historically laparoscopy in pediatric urology was very controversial. His overall comment agreed with the study that laparoscopy is beneficial in children. Here at The Children's Hospital of Philadelphia we have a number of laparoscopic and robotic redo pyeloplasties which all have went well. Both the children and family comment on how much easier it was for the child to undergo the laparoscopic procedure than the primary open surgery. We also feel that stenting a redo pyeloplasty is critical. We place a stent in our redo pyeloplasties at the beginning of the case. The previous surgery and reasons why they were failures, such as urinoma formation; excessive scarring, or malrotation of the anastomosis causes a dense fibrotic retroperitoneal reaction. Stenting helps identify the ureter at the area of the ureteral pelvic junction more readily.

Piaggio LA, Noh PH, Gonzalez R.

The Journal of Urology. 177(5):1878-1882, May 2007
doi:10.1016/j.juro.2007.01.053

Reported by UroToday.com Contributing Editor Pasquale Casale, M.D

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