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Dorsal lumbotomy incision for pediatric pyeloplasty--a good alternative
Insights
The dorsal lumbotomy incision (DL) offers a safe and effective alternative for pediatric pyeloplasty, significantly reducing hospital stays and recovery times compared to the conventional loin incision (CL). This approach provides better surgical exposure, especially in infants.
Area of Science:
- Pediatric Surgery
- Urology
- Surgical Incisions
Background:
- Pyeloplasty is a common procedure for treating pelviureteric junction (PUJ) obstruction in children.
- The choice of surgical incision impacts patient recovery and surgical outcomes.
- The dorsal lumbotomy incision (DL) is an alternative to the conventional loin incision (CL) for pediatric pyeloplasty.
Purpose of the Study:
- To evaluate the value and benefits of the dorsal lumbotomy incision (DL) for pediatric pyeloplasty.
- To compare the DL incision with the conventional loin incision (CL) in terms of surgical outcomes and patient recovery.
Main Methods:
- Retrospective analysis of 91 children undergoing pyeloplasty for PUJ obstruction between 1993 and 1997.
- Comparison of DL (n=31) versus CL (n=60) groups.
- Data collected included operative time, hospital stay, return to oral intake, and complications.
Main Results:
- Median operative time was similar for both DL and CL groups (95 min).
- DL group showed significantly shorter median hospital stay (3 days vs. 7 days, P < 0.001).
- DL group had faster return to full oral intake and unrestricted activity (43 h vs. 83 h, P < 0.001).
- Surgeons reported better PUJ exposure with DL, particularly in infants.
- No operative complications were directly related to the DL incision.
Conclusions:
- The dorsal lumbotomy incision (DL) is a safe and effective alternative to the conventional loin incision (CL) for pediatric pyeloplasty.
- DL offers advantages in reduced hospital stay and faster patient recovery.
- DL may be the preferred incision for infantile pyeloplasty due to improved surgical exposure.
Abstract:
This study reviews the value and benefits of the dorsal lumbotomy incision (DL) for exposure of the pelviureteric junction (PUJ) in infantile and paediatric pyeloplasty. Ninety-one children underwent pyeloplasty for confirmed PUJ obstruction between January 1993 and December 1997. The conventional loin incision (CL) (n = 60) was used as the standard, to which DL (n = 31) was compared. Information on the duration of surgery, length of hospital stay, length of time to return to full oral intake, and complications was obtained retrospectively from the hospital chart. The results were analysed using a non-parametrical statistical analysis. Follow-up was between 6 months and 5 years (median 2.4 years). The median age at surgery was 1.5 years (1 month-14 years). The median operating time was similar in both groups (95 min). The median length of stay was 3 days for the DL group compared to 7 days for the CL group (P < 0.001). The length of hospital stay had no correlation to the patient's age at surgery or the type of postoperative analgesia used. The median time to return to full oral intake and unrestricted activity in the DL group was 43 h compared to 83 h for the CL group (P < 0.001). The surgeons found that there was better exposure of the PUJ in infants in the DL group compared to the DL incision. There were no operative complications related to the DL itself. At the time of last follow-up 3 children required re-operation for a failed pyeloplasty, 2 in the DL group. The results suggest that DL is a safe and reasonable alternative to CL in paediatric pyeloplasty and probably the incision of choice in infantile pyeloplasty.