The dorsal lumbotomy incision in pediatric urological surgery

Between January 1, 1983 and September 30, 1985, 42 upper urinary tract operations were performed using the dorsal lumbotomy incision, representing 28 per cent of all upper tract procedures performed. Operations included pyeloplasty, partial and total nephroureterectomy, pyelolithotomy, ureterolithotomy and renal exploration with cyst marsupialization. The major contraindications to lumbotomy were malignancy and malrotated or malpositioned kidneys. Patient age ranged from 1 month to 20 years. A modification of the Gil-Vernet vertical lumbotomy incision was used in all cases. This approach involves successive incisions through the layers of the lumbodorsal fascia to gain access to the kidney and ureter, and emphasizes a muscle-retracting technique. Incision of the costovertebral ligament allows 12th rib elevation and improves the exposure obtained. There were no postoperative complications related to the lumbotomy incision itself. Decreased surgical morbidity is suggested by our results. By 3 days postoperatively 64 per cent of our patients required no analgesic medication, 93 per cent were tolerating a regular diet and 83 per cent were evaluated as having a good appetite. Mean hospital length of stay for all lumbotomy patients was 5.6 days. We conclude that the dorsal lumbotomy incision can be used to perform a wide variety of upper tract operations in children, resulting in minimal morbidity and short hospital stays.