OPEN TRANSPERITONEAL PYELOPLASTY IN CHILDREN: A SINGLE CENTRE EXPERIENCE
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Keywords
Transperitoneal open pyeloplasty, Estimated blood loss, Antero posterior diameter, Hydronephrosis, Uretero pelvic junction obstruction, Parenchymal thicknes.
Abstract
Background: Open pyeloplasty for PUJ obstruction is routinely performed through retro peritoneal route. There are little data to show the significance of trans peritoneal approach for open pyeloplasty.
Objectives: To evaluate the results and complications of open Anderson hynes pyeloplasty done via trans peritoneal approach.
Methods: We retrospectively reviewed the medical records of 38 children operated via transperitoneal open pyeloplasty (TOP) between 2019 to 2023. Patients demographic characteristics, operative time,estimated blood loss(EBL), post operative complications, success rate assessed by change in degree of hydronephrosis based on measurement of antero-posterior (AP)diameter of renal pelvis and increase in parenchymal thicknes were recorded.
Results: Mean operative time was 90 minutes(80-110 min), mean EBL (Estimated blood loss) was 15ml(10-30ml). The mean hospital stay was 5days(4-7days) days. Post operative ultrasound examination showed a diminished grade of hydronephrosis and improvement in renal function in diuretic scintigraphy. Over all success rate was 93%.
Conclusion: Our result confirms that operation through transperitoneal route is within an acceptable range with a short learning curve. The advantage of a good exposure and operating over pelvi ureteric junction in a normal anatomical position is really helpful for beginers and operating in small infants.
References
2. Hashim H, Woodhouse CRJ. Ureteropelvic junction obstruction. Eur Urol Suppl 2012;11(2):25-32.
3. Nguyen HT, Herndon CD, Cooper C, Gatti J,Krisch A, Kokorowski P et al. The Society for Fetal Urology Consensus statement on the evaluation and management of antenatal hydronephrosis. J Pediatr Urol 2010;6(3):212-31.
4. Trip, B.M.; Homsy, Y.L. Neonatal hydronephrosis- The controversy and the management. Pediatr nephrol.1995,9,503-509.[Cross Ref] [PubMed]
5. Elder, J.S Antenatal hydronephrosis. Fetal and neonatal management. Pediatr. Clin. N. Am. 1997,44,1299-1321. [Cross Ref] [PubMed]
6. Open A Jayanthi VR, Koff SA. Long-term follow up of prenataly detected sever bilateral newborn hydronephrosis initialy managed nonoperatively. J Urol 2002;168:1118-1120.
7. Anderson, J.C; Hynes, W. Retrocaval ureter; a case diagnosed pre-operatively and treated successfully by a plastic operation. Br. J. Urol. 1949,21,209-214. [Cross Ref]
8. O’ Reilly, P.H.; Brooman, P.J.;Mak, S.; Jones,M.; Pickup, C.; Atkinson,C.; Pollard, A.J. The long-term results of Anderson-Hynes pyeloplasty. BJU Int. 2001, 87, 287-289. [Cross Ref]
9. Mei H, Pu J, Yang C, Zhang H, Zheng L, Tong Q. Laparoscopic versus open pyeloplasty for ureteropelvic junction obstruction in children: a systematic review and meta-analysis. J Endourol 2001; 25: 727-736.
10. Varda, B.K.; Johnson, E.K.; Clark, C.; Chung, B.I.; Nelson, C.P.; Chang, S.L. National trends of perioperative outcomes and costs for open, laparoscopic and robotic pediatric pyeloplasty. J. Urol. 2014, 191, 1090-1095. [Cross Ref]
11. Varda, B.K.; Wang, Y.; Chung B.I.; R.S.; Kurtz, M.P.; Nelson C.P.; Chang S.L. Has the robot caught up ? National trends in utilisation, perioperative outcomes, and cost for open, laparoscopic, and robotic pediatric pyeloplasty in the United States from 2003 to 2015. J. Pediatr. Urol. 2018, 14, 336.e8. [Cross Ref]
12. Kim, C. Robotic Urologic Surgery in Infants: Results and Complications. Front Pediatr. 2019, 7, 187. [Cross Ref]
13. Lee, R.S.; Retik, A.B.; Borer, J.G.; Peters, C.A. Pediatric Robot assisted laparoscopic dismembered pyeloplasty: Comparision with a cohort of open surgery. J. Urol. 2006, 175, 683-687, discussion 687. [CrossRef] [PubMd]
14. Kafka, I.Z.; Kocherov, S.; Jaber, J.; Chertin, B. Pediatric robotic-assisted laparoscopic pyeloplasty (RALP): Does weight matter? Pediatr. Surg. Int. 2019, 35, 391-396. [CrossRef] [PubMed]
15. Cornford PA, Rickwood AMK (1998) Functional results of pyeloplasty in patients with antenatally diagnosed pelviureteric junction obsruction. BJU Int 81:152-155.
16. Salih EM(2015) Morphological and functional outcome of dismemered pyeloplasty in children with unilateral ureteropelvic junction obstruction. Afr J Urol 21:174-180. https://doi org/10.1016/j.afju.2015.04.003
17. Asensio M, Gander R, Royo GF, Lloret J. Failed pyeloplasty in children: is robotic- assisted laparoscopic reoperative repair feasible? J Pediatr Urol 2015;11(2):69 e1-6.
18. Carpenter CP, Tolley E, Tourville E, Sharadin C, Giel DW, Gleason GM. Hydronephrosis after pyeloplasty: Will it go away? Urology 2018; 121:158-63.
19. Fernandez-Ibieta M, Nortes-Cano L, Guirao-Pinera MJ, Zambudio-Carmona G, Ruiz-Jimenenz JI. Radiation free monitering in long-term follow-up of pyeloplasty: are ultrasound new parameters good enough to evaluate a successful procedure ? J Pediatr Urol 2016;12(4):230 e1-7.
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Dr. Udayabhanu Dhal
Assistant Professor, Department of Pediatric Surgery, Srirama Chandra Bhanja Medical College, Cuttack, Odisha, India.
Dr. Sribatsa Nayak
Senior Resident (Academic), Department of Pediatric Surgery, Srirama Chandra Bhanja Medical College, Cuttack, Odisha, India.
Dr. Madam Mohan Majhi
Assistant Professor, Department of Social and Preventive Medicine, Srirama Chandra Bhanja Medical College, Cuttack, Odisha, India.