Transperitoneal laparoscopic pyeloplasty: a single center experience of 28 cases

Authors

  • Ranjit Chaudhary Department of Surgery, People’s College of Medical Sciences, Bhanpur, Bhopal, Madhya Pradesh, India
  • Chirag Shanti Dausage Department of Surgery, People’s College of Medical Sciences, Bhanpur, Bhopal, Madhya Pradesh, India

DOI:

https://doi.org/10.18203/2349-2902.isj20180370

Keywords:

Anderson hynes, Laparoscopic pyeloplasty, PUJO

Abstract

Background: To evaluate prospectively the results obtained in 28 patients undergoing laparoscopic pyeloplasty through transperitoneal access.

Methods: From January 2014 to June 2016, twenty-eight patients between 12 and 55 years old underwent laparoscopic pyeloplasty for primary ureteropelvic junction (UPJ) obstruction via a transperitoneal approach. Eighteen cases had the obstruction on the left side and the other ten on the right side. All patients had radiographic evidence of obstruction with signs, symptoms or deterioration of renal function. Anderson-Hynes dismembered pyeloplasty was performed in 25 patients and Fenger technique in the other 3 cases. Three patients had non-obstructing renal stones and underwent concomitant pyelolithotomy.  Patients were evaluated clinically and by imaging in the postoperative period at 3 and 6 months and then followed-up annually.

Results: The operative time ranged from 190 to 330 min. The average blood loss was 70 mL. Analgesic requirements were also minimal with patients requiring PCA for an average of 1.1 days. Average days to free fluids were 1.5 days. The mean hospital stay was 3.76 days. The time to return to normal activities ranged from 7 to 12 days. Crossing vessels were identified in 16 patients, intrinsic stenosis in 14 patients and 5 patients had high implantation of the ureter. There were no conversions to open. One patient had longer urinary fistula (9 days), 2 patients had prolonged ileus and 3 patients had port site infection. The follow up ranged from 6 to 72 months. From the later postoperative complications, 2 patients had re-stenosis. The success rate was 92.85%.

Conclusions: Laparoscopic pyeloplasty has functional results comparable to conventional open technique. It offers less morbidity, with aesthetic and post-operative convalescence benefits and lower complication rates.

References

Abtar AN. Laparoscopic Vs Open Pyeloplasty. World J Laparoscopic Surg. 2011;4(3):146-8.

Schuessler WW, Grune MT, Tecuanhuey LV, Preminger GM. Laparoscopic dismembered pyeloplasty. J Urol. 1993;150(6):1795-9.

Wein AJ, Kavoussi LR, Novick A, Partin AW, Peters CA. Campbell- Walsh Urology. 10th edition. Elseivier; 2011.

Jarrett TW, Chan DY, Charambura TC. Laparoscopic pyeloplasty: the first 100 cases. J Urol. 2002;167 (3):1253-6.

Madi R, Roberts WW, Wolf JJS. Late failures after laparoscopic pyeloplasty. Urol. 2008;71(4);677-80.

Thomas JC, DeMarco RT, donohoe JM. Management of failed pyeloplasty: a contemporary review. J Urol. 2005; 174:2363.

Bauer JJ, Bishoff JT, Moore RG, Chen RN, Iverson AJ, Kavoussi LR. Laparoscopic versus open pyeloplasty: assessment of objective and subjective outcome. J Urol. 1999; 162:692-5.

Soulie M, Salomon L, Patrad JJ, Mouly P, Manunta A, Antiphon P, et al. Extraperitoneal laparoscopic pyeloplasty: a multicenter study of 55 procedures. J Urol. 2001;166(1):48-50.

Klinger H, Remzi M, Janetschek G, Kratzik C, Marberger MJ. Comparison of Open versus Laparoscopic Pyeloplasty Techniques in Treatment of Uretero-Pelvic Junction Obstruction. Eur Urol. 2003;44(3):340-5.

Simforoosh N, Basiri A, Tabibi A. A comparision between laparoscopic and open pyeloplasty in patient with ureteropelvic junction obstruction. Urol J. 2004;1(3):165-9.

Calvert RC, Morsy MM, Zelhof B, Rhodes M, Burgess NA. Comparision of laparoscopic and open pyeloplasty in 100 patients with pelvi- ureteric junction obstruction. Surg Endosc. 2008;22(2):411-4.

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Published

2018-01-25

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Original Research Articles