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Is Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction in Infants Under 1 Year of Age a Good Option?
Front Pediatr 2019; 7:352FP

Abstract

Purpose:

Laparoscopic pyeloplasty in children younger than 1 year of age is still debatable due to its supposed technical difficulties and failure rate. We present our experience and outcome in infants. Materials and

Methods:

A retrospective study was conducted in 3 Departments of Pediatric Surgery. We reviewed the records of the children under 1 year of age operated on for ureteropelvic junction obstruction (UPJO), between 2007 and 2017. Anderson-Hynes laparoscopic transabdominal dismembered pyeloplasty was performed. Patients' demographics, results of preoperative and postoperative exams, perioperative details, complications, hospital stay, and long-term follow-up results were analyzed.

Results:

Sixty cases were operated on during this period (49 boys, 11 girls). Mean age at operation was 4.5 months (1-12 months). Mean operating time was 140 min (80-240 min). There was no conversion in this group. There were four early complications: 1 ileus, 1 hypertension immediately post-operatively requiring medical treatment, 1 omental herniation through a drain orifice, and 1 percutaneous transanastomotic stent migrated intra-abdominally. The two last children had to be reoperated. Mean hospital stay was of 2 days (1-10 days). Late complications: two patients (3.4%) presented a recurrence of UPJO, one had been re-operated 15 months later and for the patient with persistent hypertension, nephropexy was performed for malrotated kidney, 1 year after pyeloplasty. Long term follow-up with a mean of 2.8 years (1-10 years) showed that surgery improved mean pelvic dilatation from 31.8 mm (13-63 mm) preoperatively to 15.3 mm (4-40 mm) postoperatively (P < 0.0001). The renal function slightly improved, from a mean of 35.7% (5-55%) it passed to 40.5% (0-54%), p = 0.137. In three cases the operated kidney became finally non-functional and atrophic.

Conclusions:

Laparoscopic transperitoneal pyeloplasty is feasible and safe in children younger than 1 year of age. Nevertheless, it requires experience and good intra-abdominal suturing skills. Laparoscopic pyeloplasty has a success rate comparable with open treatment but with less morbidity and better cosmetic results.

Authors+Show Affiliations

Hôpital Universitaire Des Enfants Reine Fabiola, Université Libre de Bruxelles (ULB), Brussels, Belgium.Hôpital Universitaire Des Enfants Reine Fabiola, Université Libre de Bruxelles (ULB), Brussels, Belgium.Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France.Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France.Hôpital Universitaire Des Enfants Reine Fabiola, Université Libre de Bruxelles (ULB), Brussels, Belgium.Hôpital Universitaire Des Enfants Reine Fabiola, Université Libre de Bruxelles (ULB), Brussels, Belgium.Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg.Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France.Hôpital Universitaire Des Enfants Reine Fabiola, Université Libre de Bruxelles (ULB), Brussels, Belgium.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31608264

Citation

Zamfir Snykers, Corina, et al. "Is Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction in Infants Under 1 Year of Age a Good Option?" Frontiers in Pediatrics, vol. 7, 2019, p. 352.
Zamfir Snykers C, De Plaen E, Vermersch S, et al. Is Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction in Infants Under 1 Year of Age a Good Option? Front Pediatr. 2019;7:352.
Zamfir Snykers, C., De Plaen, E., Vermersch, S., Lopez, M., Khelif, K., Luyckx, S., ... Steyaert, H. (2019). Is Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction in Infants Under 1 Year of Age a Good Option? Frontiers in Pediatrics, 7, p. 352. doi:10.3389/fped.2019.00352.
Zamfir Snykers C, et al. Is Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction in Infants Under 1 Year of Age a Good Option. Front Pediatr. 2019;7:352. PubMed PMID: 31608264.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Is Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction in Infants Under 1 Year of Age a Good Option? AU - Zamfir Snykers,Corina, AU - De Plaen,Elea, AU - Vermersch,Sophie, AU - Lopez,Manuel, AU - Khelif,Karim, AU - Luyckx,Stephane, AU - Philippe,Paul, AU - Varlet,Francois, AU - Steyaert,Henri, Y1 - 2019/09/25/ PY - 2019/03/13/received PY - 2019/08/07/accepted PY - 2019/10/15/entrez PY - 2019/10/15/pubmed PY - 2019/10/15/medline KW - children under 1 year of age KW - hydronephrosis KW - infants KW - laparoscopic pyeloplasty KW - renal function KW - ureteropelvic junction obstruction SP - 352 EP - 352 JF - Frontiers in pediatrics JO - Front Pediatr VL - 7 N2 - Purpose: Laparoscopic pyeloplasty in children younger than 1 year of age is still debatable due to its supposed technical difficulties and failure rate. We present our experience and outcome in infants. Materials and Methods: A retrospective study was conducted in 3 Departments of Pediatric Surgery. We reviewed the records of the children under 1 year of age operated on for ureteropelvic junction obstruction (UPJO), between 2007 and 2017. Anderson-Hynes laparoscopic transabdominal dismembered pyeloplasty was performed. Patients' demographics, results of preoperative and postoperative exams, perioperative details, complications, hospital stay, and long-term follow-up results were analyzed. Results: Sixty cases were operated on during this period (49 boys, 11 girls). Mean age at operation was 4.5 months (1-12 months). Mean operating time was 140 min (80-240 min). There was no conversion in this group. There were four early complications: 1 ileus, 1 hypertension immediately post-operatively requiring medical treatment, 1 omental herniation through a drain orifice, and 1 percutaneous transanastomotic stent migrated intra-abdominally. The two last children had to be reoperated. Mean hospital stay was of 2 days (1-10 days). Late complications: two patients (3.4%) presented a recurrence of UPJO, one had been re-operated 15 months later and for the patient with persistent hypertension, nephropexy was performed for malrotated kidney, 1 year after pyeloplasty. Long term follow-up with a mean of 2.8 years (1-10 years) showed that surgery improved mean pelvic dilatation from 31.8 mm (13-63 mm) preoperatively to 15.3 mm (4-40 mm) postoperatively (P < 0.0001). The renal function slightly improved, from a mean of 35.7% (5-55%) it passed to 40.5% (0-54%), p = 0.137. In three cases the operated kidney became finally non-functional and atrophic. Conclusions: Laparoscopic transperitoneal pyeloplasty is feasible and safe in children younger than 1 year of age. Nevertheless, it requires experience and good intra-abdominal suturing skills. Laparoscopic pyeloplasty has a success rate comparable with open treatment but with less morbidity and better cosmetic results. SN - 2296-2360 UR - https://www.unboundmedicine.com/medline/citation/31608264/Is_Laparoscopic_Pyeloplasty_for_Ureteropelvic_Junction_Obstruction_in_Infants_Under_1_Year_of_Age_a_Good_Option L2 - https://doi.org/10.3389/fped.2019.00352 DB - PRIME DP - Unbound Medicine ER -