RETROPERITONEAL LAPAROSCOPIC DISMEMBERED PYELOPLASTY IN CHILDREN

RETROPERITONEAL LAPAROSCOPIC DISMEMBERED PYELOPLASTY IN CHILDREN: PRELIMINARY EXPERIENCES.

Ngo Dai Hai, Nguyen Tuan Vinh, Vu Le Chuyen * Y hoc TP. Ho Chi Minh * Vol. 16 - No 4- 2012: 200 - 205

Objectives: To assess the feasibility, safety and efficacy of retroperitoneal laparoscopic dismembered pyeloplasty for treating ureteropelvic junction (UPJ) Obstruction in children.

Materials and Methods: From May 2006 to December 2011, at Urology Departments of Binh Dan Hospital, 96 patients with primary UPJ obstruction underwent retroperitoneal laparoscopic pyeloplasty, in which there were 16 children. We used laparoscopic instruments of Storz with 10mm laparoscope, 5 -10mm trocars. A three to four - port, balloon - dissecting technique was used. The type of UPJ repair performed was dismembered Anderson - Hynes. All anastomoses were completed intracorporally with 4.0 Vicryl sutures. Ureteral transposition was performed as needed. The JJ stent was removed after 4 to 6 weeks and ultrasonography, IVP or

ĐẶT VẤN ĐỀ

Diuretic renal scan were performed at 3 to 6 months or 12 months as indicated. The outcome of 16 pediatric patients was assessed during intraoperative and postoperative period.

Results: All laparoscopical operations were successfully completed. Mean operating time was 123.13 minutes (90 -195). Mean estimated blood loss was 8.94 ml (3 - 30). Mean hospital stay was 5.38 days (4 - 7). A crossing vessel was found in 4 patients (25%). No remarkable intraoperative complication occurred, There were 9 cases of mild subcutaneous emphysema. No postoperative complications. Mean following up period was 29.5 months (7 - 72). Fifteen patients (93,8%) Were asymptomatic and had improved hydronephrosis on IVP or UPJ drainage in diuretic renal scan. One patient underwent retrograde endopyelotomy due to recurrent hydronephrosis at 20 months.

Conclusions: In our condition, retroperitoneal laparoscopic dismembered pyeloplasty is a safe and effective alternative treatment for UPJ obstruction in children.

Key words: Ureteropelvic junction obstruction, dismembered pyeloplasty, retroperitoneal laparoscopy.