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Retroperitoneoscopic One-Trocar-Assisted Pyeloplasty in Children: An Age-Related Evaluation
Giovanni Cobellis1, Fabiano Nino1, Francesco Pierangeli1
1Pediatric Surgery Unit, Salesi Children's Hospital, Università Politecnica delle Marche , Ancona, Italy .
Insights
Retroperitoneoscopic one-trocar-assisted pyeloplasty (OTAP) is effective for pediatric ureteropelvic junction obstruction in children under 6 years. Older children experienced longer operative times and higher conversion rates with OTAP.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Surgical Outcomes
Background:
- Ureteropelvic junction (UPJ) obstruction is a common cause of hydronephrosis in children.
- Pyeloplasty is the gold standard surgical treatment for UPJ obstruction.
- Retroperitoneoscopic one-trocar-assisted pyeloplasty (OTAP) offers a minimally invasive approach.
Purpose of the Study:
- To evaluate the efficacy of retroperitoneoscopic one-trocar-assisted pyeloplasty (OTAP).
- To assess OTAP outcomes in pediatric patients across different age groups.
Main Methods:
- Retrospective review of 70 children undergoing OTAP for UPJ obstruction (2006-2014).
- Patients were stratified into three age groups: <2 years, 2-6 years, and >6 years.
- Surgical management, operative time, conversion rates, and recurrence were analyzed.
Main Results:
- No intraoperative complications were reported.
- Mean operative time was significantly longer in children older than 6 years compared to younger groups.
- Conversion rates were highest in the oldest age group (56.25%).
- Recurrence was observed in 3 patients (2 in the youngest group, 1 in the oldest).
Conclusions:
- OTAP is a viable and effective treatment for UPJ obstruction in children younger than 6 years.
- OTAP presents greater challenges in older children due to anatomical factors.
- Further research may explore modifications for optimizing OTAP in older pediatric populations.
Introduction:
The aim of this study was to evaluate the efficacy of the retroperitoneoscopic one -trocar -assisted pyeloplasty (OTAP) in children of different ages.
Materials And Methods:
Clinical data of all children who underwent OTAP for ureteropelvic junction (UPJ) obstruction at our Institution, between 2006 and 2014, were reviewed by focusing on demographics, surgical management, and outcomes. Data were analyzed by dividing patients into three groups according to age at operation: patients younger than 2 years (group 1), between 2 and 6 years (group 2), and older than 6 years (group 3).
Results:
During the study period, 70 children (50 males) underwent OTAP (45 left and 25 right). A 10-mm ballooned trocar was inserted under the 11-12th rib and pneumoretroperitoneum was induced (12 mmHg pressure). Through an operative scope, the UPJ was carefully mobilized and exteriorized to the skin level to perform conventional Anderson-Hynes dismembered pyeloplasty. Mean age was 48 months (range, 1 month-14 years). Thirty-six patients (mean age 8.8 months) were in G1, 18 patients (mean age 4.2 years) in G2, and 16 patients (mean age 10.2 years) in G3. There were no intraoperative complications. Mean operative time was 137 minutes: 128 minutes (range, 85-213) in G1, 118 minutes (range, 90-215) in G2 (P > .05 versus G1), and 154 minutes (range, 95-215) in G3 (P < .05 versus G1; P < .05 versus G2). Conversion (an extension of the subcostal incision) rate was 27.1%: 16.6% in G1, 22.2% in G2 (P > .05 versus G1), and 56.25% in G3 (P < .05 versus G1; P < .05 versus G2). At a mean follow-up of 29 months (range, 12 months-5 years), recurrence was observed in 3 patients (2 G1, 1 G3).
Conclusions:
Our results show that OTAP is a good alternative in children younger than 6 years. OTAP is more challenging in older children because of the thickness of the abdominal wall and the higher incidence of aberrant crossing vessels.
