Laparoscopic transperitoneal heminephrectomy for duplex kidney in infants and children: A comparative study

摘要

Background and Objective: Evaluation of the feasibility, safety, and outcome of laparoscopic heminephrectomy for duplex kidneys in children above and below the age of 12 months. Patients and Methods: The transperitoneal surgical technique included division of the parenchyma with a sealing device (LigaSure?; Covidien, Mansfield, MA) and amputation of the ureter as low as possible. A follow-up study was performed. Patients' records were analyzed retrospectively for operative details and postoperative complications. Long-term outcome was assessed during follow-up visits and a final telephone interview. Outcome was compared between two groups: Group 1 (G1), age at surgery<12 months; Group 2 (G2), age at surgery >12 months. Results: Between July 2004 and September 2012, in total, 22 laparoscopic heminephrectomies (20 upper poles and 2 lower poles) were performed in 20 patients (G1, 12 cases; G2, 10 cases). A mean (range) age at surgery was 7.1 (3-11) months in G1 and 49.4 (15-128) months in G2. Mean (range) operative time was 152 (81-220) min in G1 and 197 (90-265) min in G2 (P=.06). All procedures were completed laparoscopically. Major postoperative complication was one urinoma in G1, which was surgically revised. Mean hospital stay was 3.6 days (G1, 4.0 days; G2, 3.1 days). During long-term follow-up (median, 5.2 years) febrile urinary tract infections occurred to the same extent in both groups (G1, 1/12; G2, 2/10; P=.57). Conclusions: Laparoscopic transperitoneal heminephrectomy for duplex kidneys is safe and feasible even in small infants. Long-term results are excellent irrespective of the patient's age.