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Outcome based comparison of surgical approaches for pediatric pyeloplasty: dorsal lumbar versus flank incision
1Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA.
Insights
The dorsal lumbar incision for dismembered pyeloplasty is a safe and effective surgical approach. It offers faster operative times in older children and shorter hospital stays for infants compared to the flank incision.
Area of Science:
- Pediatric Urology
- Surgical Techniques
- Ureteral Surgery
Background:
- Ureteropelvic junction (UPJ) obstruction is a common cause of hydronephrosis in children.
- Dismembered pyeloplasty is the gold standard surgical repair for UPJ obstruction.
- Surgical approaches include flank and dorsal lumbar incisions.
Purpose of the Study:
- To compare the efficacy and outcomes of dismembered pyeloplasty using flank versus dorsal lumbar incisions in pediatric patients.
- To determine if one surgical approach offers advantages in terms of operative time, hospital stay, and cost.
Main Methods:
- Retrospective review of 33 pediatric patients undergoing simple dismembered pyeloplasty.
- Patients were divided into two groups: flank incision (1992-1993) and dorsal lumbar incision (post-1993).
- Data analyzed included operative time, hospital stay, costs, success rates, and complications.
Main Results:
- No significant difference in overall operative time or success/complication rates between the two groups.
- Dorsal lumbar incision was significantly faster for children over 1 year old (108.5 vs. 144.4 minutes).
- Infants (excluding bilateral cases) had shorter hospital stays with dorsal lumbar incision (25.7 vs. 73 hours).
Conclusions:
- The dorsal lumbar incision is a safe, effective, and potentially more cost-effective approach for pediatric pyeloplasty.
- This approach demonstrates improved operative times in older children and reduced hospital stays in infants.
- Outcomes appear comparable or superior to endoscopic methods.
Purpose:
Dismembered pyeloplasty for the correction of ureteropelvic junction obstruction can be performed through a flank or dorsal lumbar incision. We compared the records of children who had undergone pyeloplasty by each approach to determine if 1 technique was more advantageous.
Materials And Methods:
We retrospectively reviewed the records of 33 consecutive children undergoing simple dismembered pyeloplasty by a single pediatric urologist from 1992 to 1996. The flank approach was used exclusively in the first group of patients who underwent repair in 1992 to 1993 and the dorsal lumbar incision was used exclusively in the second group after 1993. Data were obtained from hospital and clinic records, and both groups were compared with the 2-tailed t test.
Results:
Pyeloplasty was done by dorsal lumbar incision in 16 cases and via the flank approach in 17. One patient in each group had undergone simultaneous bilateral pyeloplasties. Although overall comparison of both groups revealed no differences in operative time, in children older than 1 year pyeloplasty through a dorsal lumbar incision (108.5 minutes) was statistically significantly faster than the flank approach (144.4 minutes). Hospital stay was approximately 2 days shorter in infants who had a dorsal lumbar (25.7 hours) versus a flank incision (73 hours), and this difference did reach statistical significance if the bilateral pyeloplasty patients were excluded. Hospital costs were less for the dorsal lumbar group but the difference was not statistically significant. Success and complication rates were similar between groups with 2 patients in each group requiring additional procedures. Review of other series of repair of ureteropelvic junction obstruction demonstrated that the dorsal lumbar repair had equivalent or shorter operative times and lengths of hospitalization compared to newer endoscopic methods, and the outcomes were superior.
Conclusions:
The dorsal lumbar incision is a safe and efficacious approach to pyeloplasty and may be more cost-effective. In our series it was significantly faster in patients older than 1 year and resulted in shorter hospital stays in those younger than 1 year old.