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The outcomes of mini-laparoscopic pyeloplasty in children - brazilian experience
Cristiane Reis Leonardo1, Alexandra Muzzi2, José Eduardo Tavora3
1Departamento de Urologia Pediátrica, Neocentro - Hospital Vila da Serra, Nova Lima, MG, Brasil.
Insights
Laparoscopic pyeloplasty (LP) in children is a safe and effective treatment for pelviureteric junction (PUJ) obstruction, achieving a 94.7% success rate. This minimally invasive approach offers good functional and cosmetic outcomes comparable to open surgery.
Area of Science:
- Pediatric surgery
- Urology
- Minimally invasive surgery
Background:
- Pelviureteric junction (PUJ) obstruction is a leading cause of childhood hydronephrosis.
- Open pyeloplasty is the established gold standard treatment with over 90% success.
Purpose of the Study:
- To evaluate the outcomes of laparoscopic pyeloplasty (LP) as an alternative treatment for PUJ obstruction in children.
- To assess the safety, efficacy, and cosmetic results of LP in a pediatric cohort.
Main Methods:
- A retrospective review of 38 children (aged 2-60 months) who underwent LP for PUJ obstruction between June 2015 and December 2017.
- The Anderson-Hynes pyeloplasty technique was employed, with data collected on operative time, complications, hospitalization, and postoperative outcomes.
Main Results:
- The mean operative time was 107 minutes, with no conversions to open surgery.
- Mean hospitalization was 2 days, and the mean reduction in renal pelvis anteroposterior diameter was 41% (p<0.001).
- An overall success rate of 94.7% was achieved, with good cosmetic results and minimal complications.
Conclusions:
- Laparoscopic pyeloplasty demonstrates favorable functional and cosmetic results in children with PUJ obstruction.
- LP is a viable alternative to open surgery, offering comparable success rates regardless of patient age.
Abstract:
Objetive: Pelvicureteric junction (PUJ) obstruction is the main cause of hydronephrosis in childhood. Open pyeloplasty has been the gold standard treatment of this condition with success rate above 90%. The role of laparoscopic pyeloplasty (LP) in children is less well defined and has slowly emerged as an alternative procedure. We report outcomes of our initial experience with LP in 38 children from 2 months of age.
Materials And Methods:
From June 2015 to December 2017 38 children aged 2-60 months (mean age 1.7 years) underwent LP for correction of PUJ obstruction. The mean pre operative anteroposterior diameter of the renal pelvis (APD) was 43,5mm and all patients had hydronephrosis (APD 21.4-76 mm) and obstructed curve on diuretic renogram. Anderson-Hynes pyeloplasty was the performed technique. Results are reported.
Results:
Mean operative time was 107 minutes (70-180) with no conversion to open procedure. Pain control was needed mainly in the fi rst 12hs. Mean hospitalization was 2 days (1-5). There were complications in 5 children not affecting the fi nal outcome. Two patients had a re-obstruction requiring a second procedure with good result. The mean follow up was 18 months (13-36). The mean reduction on the postoperative APD was 41% - p<0,001 (end APD 5 to 41mm). Overall success rate was 94,7%. All children had good cosmetic results.
Conclusions:
This is a small series limited by short follow up, however its data suggest that LP has good functional and cosmetic results, not compromising the success of the open procedure, regardless patient age.
