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Laparoscopic dismembered pyeloplasty in 47 cases.

Mitre AI, Brito AH, Srougi M - Clinics (Sao Paulo) (2008)

Bottom Line: In 44 (93.6%) of the 47 patients, resolution of the pain and a reduction in ureteropelvic dilation were observed.The presence of crossing vessels over the ureteropelvic junction was verified in 26 patients (55%), and vessel transposition in relation to the urinary tract was performed in 25 of these cases.In one patient, the crossing vessel was mobilized out of the ureteropelvic junction with a perivascular suture to the renal capsule associated with the pyeloplasty.

View Article: PubMed Central - PubMed

Affiliation: Division of Urology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.

ABSTRACT

Purpose: To evaluate the results of a sequence of 47 laparoscopic Anderson-Hynes pyeloplasties for the treatment of patients with ureteropelvic junction obstruction, independently of the etiology.

Materials and methods: Twenty male and 27 female patients diagnosed with ureteropelvic junction obstruction were treated by Anderson-Hynes transperitoneal laparoscopic dismembered pyeloplasty from April 2002 to January 2006. The age of the patients ranged from four to 75 years, with a mean age of 32.3 years. The follow-up ranged between six and 30 months, with a mean follow-up time of 24 months. The outcomes were evaluated through the assessment of symptoms and imaging studies.

Results: In 44 (93.6%) of the 47 patients, resolution of the pain and a reduction in ureteropelvic dilation were observed. The mean operative time was 157 minutes (ranging from 90 to 270 minutes). Neither blood transfusion nor conversion to open surgery was required. The mean hospital stay was 2.2 days. The presence of crossing vessels over the ureteropelvic junction was verified in 26 patients (55%), and vessel transposition in relation to the urinary tract was performed in 25 of these cases. In one patient, the crossing vessel was mobilized out of the ureteropelvic junction with a perivascular suture to the renal capsule associated with the pyeloplasty.

Conclusions: The outcome of transperitoneal Anderson-Hynes laparoscopic pyeloplasty used for different causes of pyeloureteral obstruction presented a success rate similar to a previously-published open procedure, with the advantage of being less invasive. This procedure may be considered the first option for the treatment of ureteropelvic junction obstruction.

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Port sites demonstrated as surgical scars after left side laparoscopic pyeloplasty
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f1-11-0100: Port sites demonstrated as surgical scars after left side laparoscopic pyeloplasty

Mentions: The preoperative preparation consisted of a liquid diet for the last meal followed by an eight-hour fast. Prophylactic cephalothin at the usual doses was administered endovenously one hour prior to the procedure. The patients underwent general anesthesia that was sometimes associated with epidural anesthesia, at the discretion of the anesthetist. An orogastric or nasogastric tube and a Foley bladder catheter were inserted prior to the procedure. The Foley catheter was kept closed until double J intra-operative antegrade introduction. The patient was positioned in a lateral decubitus, 45° in relation to the horizontal plane, and was supported by cushions and fixed to the surgical table with a wide adhesive tape. Surgical time was defined as the period from the first skin incision for insertion of the first trocar to the last stitch in the skin following all procedures. After insertion of a Veress needle into the abdominal cavity at the upper border of the umbilicus, pneumoperitoneum was established at 15 mmHg pressure. The first 10 mm trocar for a 30° optical system was then inserted. The second and third 5 mm trocars were placed at the midclavicular line - one in the subcostal region and the other on a horizontal line slightly below the umbilicus at the same side of the obstruction (Figure 1). When necessary, the insertion of the fourth trocar was performed at a different site, depending on the side. On the left side, it was placed below the xiphoid process, and on the right, it was placed at the intersection of the anterior axillary line with a horizontal line at the level of the umbilicus. The paracolic sulcus was incised and the colon was displaced medially. The upper ureter was identified laterally to the gonadal vein and dissected cranially to the renal pelvis. When crossing vessels over the ureteropelvic junction were present, they were dissected and separated from the urinary tract. The obstructed ureteropelvic junction was then excised and the renal pelvis was anteriorly transposed in relation to the vessels. The ureter was spatulated laterally to increase the perimeter of the anastomosis. The anastomosis between the ureter and the renal pelvis was performed with a 4-0 Vicryl running suture with an atraumatic needle. After the conclusion of the posterior suture, a double J catheter was antegradely inserted into the ureter up to be bladder via the subcostal trocar, and its cranial extremity was placed in the renal pelvis. The smooth catheter progression indicated that the double J catheter was well positioned. The remaining anterior half of the anastomosis was then completed. The peritoneal cavity was drained with a thin Penrose drain for 24 hours. The nasogastric tube was removed at the end of the surgical procedure and the Foley catheter was left in place for 48 hours. The double J catheter was removed after 4 weeks. The outcomes were evaluated with a minimum 4-month postoperative follow-up. We considered it a good outcome when subjective and objective data demonstrated a significant improvement of the pyeloureteral drainage and improvement of the symptoms; a poor outcome was recorded when the pain or the renal dilatation and/or function remained unchanged or worsened. The mean follow-up was 24 months. Considering the primary cases, the follow-ups ranged between 12 and 48 months, with a mean of 26.4 months. For the secondary cases, the follow-up ranged between 16 and 36 months, with a mean of 22.4 months.


Laparoscopic dismembered pyeloplasty in 47 cases.

Mitre AI, Brito AH, Srougi M - Clinics (Sao Paulo) (2008)

Port sites demonstrated as surgical scars after left side laparoscopic pyeloplasty
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2664721&req=5

f1-11-0100: Port sites demonstrated as surgical scars after left side laparoscopic pyeloplasty
Mentions: The preoperative preparation consisted of a liquid diet for the last meal followed by an eight-hour fast. Prophylactic cephalothin at the usual doses was administered endovenously one hour prior to the procedure. The patients underwent general anesthesia that was sometimes associated with epidural anesthesia, at the discretion of the anesthetist. An orogastric or nasogastric tube and a Foley bladder catheter were inserted prior to the procedure. The Foley catheter was kept closed until double J intra-operative antegrade introduction. The patient was positioned in a lateral decubitus, 45° in relation to the horizontal plane, and was supported by cushions and fixed to the surgical table with a wide adhesive tape. Surgical time was defined as the period from the first skin incision for insertion of the first trocar to the last stitch in the skin following all procedures. After insertion of a Veress needle into the abdominal cavity at the upper border of the umbilicus, pneumoperitoneum was established at 15 mmHg pressure. The first 10 mm trocar for a 30° optical system was then inserted. The second and third 5 mm trocars were placed at the midclavicular line - one in the subcostal region and the other on a horizontal line slightly below the umbilicus at the same side of the obstruction (Figure 1). When necessary, the insertion of the fourth trocar was performed at a different site, depending on the side. On the left side, it was placed below the xiphoid process, and on the right, it was placed at the intersection of the anterior axillary line with a horizontal line at the level of the umbilicus. The paracolic sulcus was incised and the colon was displaced medially. The upper ureter was identified laterally to the gonadal vein and dissected cranially to the renal pelvis. When crossing vessels over the ureteropelvic junction were present, they were dissected and separated from the urinary tract. The obstructed ureteropelvic junction was then excised and the renal pelvis was anteriorly transposed in relation to the vessels. The ureter was spatulated laterally to increase the perimeter of the anastomosis. The anastomosis between the ureter and the renal pelvis was performed with a 4-0 Vicryl running suture with an atraumatic needle. After the conclusion of the posterior suture, a double J catheter was antegradely inserted into the ureter up to be bladder via the subcostal trocar, and its cranial extremity was placed in the renal pelvis. The smooth catheter progression indicated that the double J catheter was well positioned. The remaining anterior half of the anastomosis was then completed. The peritoneal cavity was drained with a thin Penrose drain for 24 hours. The nasogastric tube was removed at the end of the surgical procedure and the Foley catheter was left in place for 48 hours. The double J catheter was removed after 4 weeks. The outcomes were evaluated with a minimum 4-month postoperative follow-up. We considered it a good outcome when subjective and objective data demonstrated a significant improvement of the pyeloureteral drainage and improvement of the symptoms; a poor outcome was recorded when the pain or the renal dilatation and/or function remained unchanged or worsened. The mean follow-up was 24 months. Considering the primary cases, the follow-ups ranged between 12 and 48 months, with a mean of 26.4 months. For the secondary cases, the follow-up ranged between 16 and 36 months, with a mean of 22.4 months.

Bottom Line: In 44 (93.6%) of the 47 patients, resolution of the pain and a reduction in ureteropelvic dilation were observed.The presence of crossing vessels over the ureteropelvic junction was verified in 26 patients (55%), and vessel transposition in relation to the urinary tract was performed in 25 of these cases.In one patient, the crossing vessel was mobilized out of the ureteropelvic junction with a perivascular suture to the renal capsule associated with the pyeloplasty.

View Article: PubMed Central - PubMed

Affiliation: Division of Urology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.

ABSTRACT

Purpose: To evaluate the results of a sequence of 47 laparoscopic Anderson-Hynes pyeloplasties for the treatment of patients with ureteropelvic junction obstruction, independently of the etiology.

Materials and methods: Twenty male and 27 female patients diagnosed with ureteropelvic junction obstruction were treated by Anderson-Hynes transperitoneal laparoscopic dismembered pyeloplasty from April 2002 to January 2006. The age of the patients ranged from four to 75 years, with a mean age of 32.3 years. The follow-up ranged between six and 30 months, with a mean follow-up time of 24 months. The outcomes were evaluated through the assessment of symptoms and imaging studies.

Results: In 44 (93.6%) of the 47 patients, resolution of the pain and a reduction in ureteropelvic dilation were observed. The mean operative time was 157 minutes (ranging from 90 to 270 minutes). Neither blood transfusion nor conversion to open surgery was required. The mean hospital stay was 2.2 days. The presence of crossing vessels over the ureteropelvic junction was verified in 26 patients (55%), and vessel transposition in relation to the urinary tract was performed in 25 of these cases. In one patient, the crossing vessel was mobilized out of the ureteropelvic junction with a perivascular suture to the renal capsule associated with the pyeloplasty.

Conclusions: The outcome of transperitoneal Anderson-Hynes laparoscopic pyeloplasty used for different causes of pyeloureteral obstruction presented a success rate similar to a previously-published open procedure, with the advantage of being less invasive. This procedure may be considered the first option for the treatment of ureteropelvic junction obstruction.

Show MeSH
Related in: MedlinePlus