UroToday - This is a study from Gujarat, India regarding transperitoneal laparoscopic pyeloplasty in children. This group reported their technique and outcome with laparoscopic transperitoneal dismembered pyeloplasty in the pediatric population. They had 19 patients ranging from 2-14 years of age who underwent laparoscopic pyeloplasty between June 2004 and December 2006. Of the 19 patients 13 pyeloplasties were performed on the left and 6 on the right. A transmesenteric approach was utilized in 5 left sided UPJ obstructions. All the operations were performed by the transperitoneal route either using 3 or 4 ports.
Overall 16 patients underwent dismembered pyeloplasty while 3 had non-dismembered Foley YV pyeloplasties. Mean operative time was 198 minutes, ranging from 105-300. Mean estimated blood loss was 45 ml. The mean length of stay was 4 days. Mean follow-up was 13.8 months with a range of 2 to 30. Postoperatively one child had urinary tract infection that necessitated hospitalization and intravenous antibiotics. 18 of the 19 patients demonstrated improved drainage with no evidence of obstruction on diuretic renography or IVP. One patient is still awaiting follow-up. There was no conversion to open surgery. The group concluded that laparoscopic pyeloplasty in children is safe and a good minimally invasive option that replicates the principles of open surgery. They do state it is technically challenging and with increase in the expertise, their times were reduced significantly.
This is a study that adds to the argument that transperitoneal laparoscopic pyeloplasty is in the mainstream for pediatric UPJ obstruction. Unfortunately it did not add much to the literature that is already in existence. Actually, it added more questions to why the mean length of stay was four days for these patients that typically go home within a 24 hour period here in the United States. If the mean length of stay was four days due to social reasons, it would have been nice to have it elaborated even further. Nonetheless, it is nice to see that laparoscopic pyeloplasty in children continues to grow worldwide and its acceptance to open pyeloplasty is just about equal.
Singh H, Ganpule A, Malhotra V, Manohar T, Muthu V, Desai M
Journal of Endourology. December 1, 2007, 21(12): 1461-1466 doi:10.1089/end.2007.0023
Reported by UroToday Medical Editor Pasquale Casale, MD Assistant Professor, University of Pennsylvania University of Pennsylvania, Children's Hospital of Philadelphia
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