Technical considerations in retroperitoneoscopic pyeloplasty in children: an early experience

摘要

Introduction Retroperitoneoscopic pyeloplasty is considered as one of the acceptable approaches for pelviureteric junction obstruction (PUJO) in children. Some consider it better than the open and laparoscopic approaches; but it has its own technical challenges.Objective To analyse technical aspects in the initial learning curve of retroperitoneoscopic pyeloplasty for pelviureteric junction obstruction (PUJO) in children and to discuss certain tips and tricks.Study design We retrospectively evaluated the data of consecutive 10 pelviureteric junction obstruction cases undergone retroperitoneal pyeloplasty in 2 years duration (January 2016 to December 2017). All patients had undergone ultrasound kidney ureter bladder (KUB), intravenous pyelography (IVP) and Ethylene dicysteine (EC) scan. A single surgeon operated on all the patients and placed a DJ stent intraoperatively. Postoperatively, the patients underwent an EC scan and IVP at 6 months. The patient records and operative videos were assessed.Results The average patient age was 8.4±2.31 years (5-11 years). Intraoperatively, two patients had crossing vessels and the rest 8 had intraluminal narrowing. The mean operating time was 207.5 ± 36.15 min (150-285 min) and mean hospital stay was 3 ± 1.49 days (2-7 days). The postoperative course was uneventful in almost all except one who developed perinephric collection and had to undergo pigtail drainage. On follow up, all patients showed improved drainage at the PUJ except one. Conclusion Retroperitoneoscopic pyeloplasty for pelviureteric junction obstruction can be optimally practiced by understanding the technical difficulties associated with it and the corresponding tips to ease the procedure. The advantages of going retroperitoneoscopically can be achieved and utilised in full for the benefit of the patient.