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Laparoscopic upper pole heminephroureterectomy in children: Seven-year experience

Authors :
Antonio Marte
Alfonso Papparella
Lucia Pintozzi
Source :
African Journal of Paediatric Surgery, Vol 12, Iss 4, Pp 227-231 (2015)
Publication Year :
2015
Publisher :
Wolters Kluwer Medknow Publications, 2015.

Abstract

Background: Minimally invasive surgery is the current approach to perform heminephroureterectomy (HN) in children. This can be obtained through a transperitoneal (TP) or a retroperitoneal approach. Here, we report our experience using a TP approach. Materials and Methods: From 2005 to 2014, 22 TP laparoscopic upper poles HN were performed at our institution. There were nine girls and 13 boys aged between 20 months and 6 years (mean age 3.9). Eight patients were diagnosed prenatally, 17 patients presented with urinary tract infection (UTI) and three with vomiting and failure to thrive. The indication for HN was reflux nephropathy and UTI in non-functioning upper pole in 19 patients and cystic dysplasia in 1 patient. The surgical technique involved the following steps: Cystoscopic recognition; positioning of 3-4 trocar (right HN); identification of the kidney (detachment of the colon); isolation and low ligation of the dilated ureter; decrossing from renal vessels; section of the parenchyma by LigaSure; haemostasis with clips and LigaSure; drain. Results: The mean operative time was 154 min (range: 81-220 min). All patients were discharged from the 2 nd to 4 th day. Neither major complication nor conversion was recorded. 1 patient presented leakage of urine for 7 days from the drainage which resolved spontaneously. At ultrasound follow-up, 5 patients showed a secondary perirenal cyst, 2-5 cm diameter that resolved spontaneously. Conclusion: The results indicate that laparoscopic upper pole heminephrectomy is the treatment of choice in cases of non-functioning dilated lower segments of duplicated kidneys. The use of laparoscopic approach offers a good working space, a good visual control of the vessels and allows a very low isolation of the ureteral stump which counterbalance the peritoneal violation.

Details

Language :
English
ISSN :
01896725 and 09745998
Volume :
12
Issue :
4
Database :
Directory of Open Access Journals
Journal :
African Journal of Paediatric Surgery
Publication Type :
Academic Journal
Accession number :
edsdoj.14042ae7be834e06bc17c394ff2a9a4d
Document Type :
article
Full Text :
https://doi.org/10.4103/0189-6725.172546