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Pyeloplasty in children by lumbotomy approach using infant feeding tube as single stent
Amit Singh, Minu Bajpai1, Manisha Jana
1Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.
Insights
Infant feeding tubes (IFT) used as a single stent in pediatric pyeloplasty offer effective drainage and avoid complications. This approach demonstrates a high success rate, proving a cost-effective and readily available alternative.
Area of Science:
- Pediatric Urology
- Surgical Innovation
- Medical Device Application
Background:
- Pyeloplasty is a common procedure for pediatric pelvi-ureteric junction obstruction (PUJO).
- Traditional stenting methods involve double-J stents or nephrostomies, each with potential complications.
- The lumbotomy approach offers a surgical route for pyeloplasty.
Purpose of the Study:
- To evaluate the efficacy of using a single infant feeding tube (IFT) as a stent in pediatric pyeloplasty performed via a lumbotomy approach.
- To assess the outcomes and complications associated with this simplified stenting technique.
Main Methods:
- A retrospective review of 134 pediatric pyeloplasty cases performed between January 2000 and December 2010 using the lumbotomy approach.
- A 5 Fr IFT with multiple holes was employed as a single stent, serving dual roles as a nephrostomy and transanastomotic stent.
- Single-layer anastomosis at the pelvi-ureteric junction was performed, with pelvic reduction if necessary.
Main Results:
- The study included 109 males and 25 females (M:F ratio 4.3:1), with 87.3% left-sided PUJO.
- Postoperative complications were low, including infection (1.5%), urinoma (0.7%), urine leak (2.2%), non-drainage (1.5%), and accidental stent removal (1.5%).
- Follow-up scans at 3 and 9 months showed improved drainage in 92.5% and preserved renal function in 96.2%, with an overall success rate of 97.5%.
Conclusions:
- Using an IFT as a transanastomotic stent in pediatric pyeloplasty provides effective drainage.
- This method avoids complications associated with double-J stents and nephrostomies.
- The IFT approach is a cost-effective and readily available alternative for pediatric pyeloplasty stenting.
Background:
The objective of this study was to assess the outcome in children who had undergone pyeloplasty by lumbotomy approach using infant feeding tube (IFT; 5 Fr) as a single stent.
Materials And Methods:
During January 2000 and December 2010, 134 pyeloplasty were performed by the lumbotomy approach. The procedure involves single layer anastomosis at pelvi-ureteric junction using vicryl 5-0/6-0 (reduction of pelvis if required). An IFT 5 Fr with multiple holes used as a single stent to serve as nephrostomy and as transanastomotic stent also.
Results:
There were 109 males and 25 females with M: F ratio of 4.3:1. Left-side pelvi-ureteric junction obstruction (PUJO) was seen in 117 (87.3%) while right side PUJO in 17 (12.7%). Mean age of presentation was 52.7 months (range 9-120 months). Postoperative complications included infection 2 (1.5%), urinoma formation 1 (0.7%), urine leak 3 (2.2%), non drainage 2 (1.5%), accidental removal of the stent 2 (1.5%). Follow-up scan done at 3 and 9 months showed improved drainage in 124 (92.5%), preserved renal function in 129 (96.2%) cases. Overall success rate 97.5%.
Conclusion:
Transanastomotic stent using IFT not only provide an effective drainage but also avoid the complications associated with double-J stents and nephrostomies, with the added benefit of being cheaper and availability.
