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Clinical value of the adjustable suspension technique in laparoscopic pyeloplasty
Long-Yao Xu1, Ling-Ling Chen2, Wen-Hua Huang1
1Department of Urology, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.
Insights
Adjustable suspension in laparoscopic pyeloplasty (ASLP) is a safe and effective minimally invasive technique for pediatric ureteropelvic junction obstruction (UPJO). ASLP showed reduced operation time, blood loss, and anastomotic leakage compared to single-line pelvis suspension (SLPSLP).
Area of Science:
- Pediatric Surgery
- Urology
- Minimally Invasive Surgery
Background:
- Ureteropelvic junction obstruction (UPJO) is a common cause of pediatric kidney obstruction.
- Laparoscopic pyeloplasty (LP) is a standard surgical treatment for UPJO.
- Different suspension techniques exist for LP, impacting outcomes.
Purpose of the Study:
- To compare the efficacy and safety of adjustable suspension in laparoscopic pyeloplasty (ASLP) versus single-line pelvis suspension in laparoscopic pyeloplasty (SLPSLP) for pediatric UPJO.
Main Methods:
- Retrospective review of clinical data from children with isolated UPJO who underwent LP.
- Data collected included patient demographics, operative details, and follow-up outcomes.
- Comparison of ASLP (n=52) and SLPSLP (n=61) groups.
Main Results:
- ASLP demonstrated significantly shorter operation duration, reduced blood loss, and faster drainage tube removal compared to SLPSLP.
- The anastomotic leakage rate was significantly lower in the ASLP group (0%) versus the SLPSLP group (6%).
- No significant differences were observed in anastomotic stenosis rates between the groups.
Conclusions:
- Adjustable suspension in laparoscopic pyeloplasty (ASLP) is a safe and effective alternative for treating pediatric UPJO.
- ASLP offers advantages of being minimally invasive with shorter operation times and less bleeding compared to SLPSLP.
- ASLP may lead to improved patient outcomes and reduced complications such as anastomotic leakage.
Objective:
The aim of our study was to explore the efficacy and safety of adjustable suspension in laparoscopic pyeloplasty (ASLP) and single-line pelvis suspension in laparoscopic pyeloplasty (SLPSLP) for isolated ureteropelvic junction obstruction (UPJO) in children.
Methods:
We retrospectively reviewed the clinical data of all the children with isolated UPJO who underwent laparoscopic pyeloplasty (LP) at Fujian Children's Hospital between July 2019 and July 2023. We collected data from the medical records of all the children and analysed their clinical characteristics as well as their operative and follow-up data.
Results:
One hundred thirteen children with isolated UPJO who had complete clinical data and underwent LP at our centre were included in this study. Fifty-two children underwent ASLP and 61 children underwent SLPSLP successfully at our centre. There was no statistically significant difference in patient age, sex, body weight, proportion of patients with a history of UTI or pain, follow-up time or side of the UPJO between the ASLP group and the SLPSLP group (P > 0.05). However, there were significant differences in the operation duration, blood loss volume, time to DJ stent extraction, time to abdominal drainage tube extraction and length of hospitalisation between the ASLP group and the SLPSLP group (P < 0.05). The APD and PT before surgery were significantly different from those 6 and 12 months after surgery in both the ASLP and SLPSLP groups (p < 0.05). The anastomotic leakage rate was significantly different between the two groups, as no patients in the ASLP group and 6 patients in the SLPSLP group experienced anastomotic leakage (P = 0.030). Anastomotic stenosis occurred in 1 patient in the ASLP group and 4 patients in the SLPSLP group, with no significant difference between the two groups (P = 0.372).
Conclusion:
Compared with SLPSLP, ASLP is advantageous in that it is minimally invasive, has a shorter operation time, and causes less bleeding. Thus, compared with conventional LP, adjustable suspension in laparoscopic pyeloplasty involving a minimally invasive fascia closure device for paediatric isolated UPJO is safe and effective.
