Complications of Laparoscopic Pyeloplasty in Children

Overview

Journal Pediatr Surg Int

Specialties General Surgery
Pediatrics

Date 2009 Mar 4

PMID 19255763

Citations 5

Authors

Rajendra B Nerli

Mallikarjun Reddy

Vikram Prabha

Ashish Koura

Praveen Patne

M K Ganesh

Affiliations

Soon will be listed here.

Abstract

Introduction: Laparoscopic pyeloplasty in children has been proven to be safe and effective, with comparable results to open surgery. Due to the extension of laparoscopic indications from ablative to reconstructive procedures requiring endoscopic suturing, most centres have plateaued within their learning curve. Based on our own experience with a little more than 100 cases, we focus on the complications and the definitive learning curve of laparoscopic pyeloplasty in children.

Materials And Methods: A total of 103 laparoscopic pyeloplasties were performed during the period January 2002 to June 2008. Of these, 102 underwent laparoscopic dismembered pyeloplasty and one underwent laparoscopic vascular hitch for crossing lower pole vessels. Intraoperative incidents/complications were analysed using the Satava classification, and the postoperative complications according to the Clavien classification.

Results: Intraoperative incidents occurred in 2.91% of the cases, mostly without consequences for the child including faulty port placement needing placement of an extra port and umbilical port side bleed. Postoperative complications occurred in 11.65% children and included prolonged ileus, prolonged urinary leak, fever, haematuria and recurrent ureteropelvic junction (UPJ) stenosis. Recurrent UPJ stenosis occurred in 4.85% of children needing reoperation.

Conclusions: Laparoscopic pyeloplasty in children is not only feasible, but safe and effective. Intraoperative incidents occur in up to 3% of the cases, and complications in 12.9-15.8%. Increased experience, training and knowledge regarding the incidence and management of complications will be able to further reduce these in the future.

Citing Articles

The construction of a nomogram to predict the prognosis and recurrence risks of UPJO.

Ma W, Gao H, Chang M, Lu Z, Li D, Ding C Front Pediatr. 2024; 12:1376196.

PMID: 38633323 PMC: 11022601. DOI: 10.3389/fped.2024.1376196.

High-pressure balloon assessment of pelviureteric junction prior to laparoscopic "vascular hitch".

Parente A, Angulo J, Romero R, Burgos L, Ortiz R Int Braz J Urol. 2016; 42(1):154-9.

PMID: 27136482 PMC: 4811241. DOI: 10.1590/S1677-5538.IBJU.2015.0343.

Morbidity assessment in surgery: refinement proposal based on a concept of perioperative adverse events.

Kazaryan A, Rosok B, Edwin B ISRN Surg. 2013; 2013:625093.

PMID: 23762627 PMC: 3671541. DOI: 10.1155/2013/625093.

Categorization of intraoperative ureteroscopy complications using modified Satava classification system.

Tepeler A, Resorlu B, Sahin T, Sarikaya S, Bayindir M, Oguz U World J Urol. 2013; 32(1):131-6.

PMID: 23504074 DOI: 10.1007/s00345-013-1054-y.

Laparoscopic pyeloplasty in pediatric patients: the SGPGI experience.

Maheshwari R, Ansari M, Mandhani A, Srivastava A, Kapoor R Indian J Urol. 2010; 26(1):36-40.

PMID: 20535282 PMC: 2878435. DOI: 10.4103/0970-1591.60441.

References

Schier F . Laparoscopic Anderson-Hynes pyeloplasty in children. Pediatr Surg Int. 1998; 13(7):497-500. DOI: 10.1007/s003830050382. View

Nguyen D, Aliabadi H, Ercole C, Gonzalez R . Nonintubated Anderson-Hynes repair of ureteropelvic junction obstruction in 60 patients. J Urol. 1989; 142(3):704-6. DOI: 10.1016/s0022-5347(17)38859-6. View

Ravish I, Nerli R, Reddy M, Amarkhed S . Laparoscopic pyeloplasty compared with open pyeloplasty in children. J Endourol. 2007; 21(8):897-902. DOI: 10.1089/end.2006.0411. View

OReilly P, Brooman P, Mak S, Jones M, Pickup C, Atkinson C . The long-term results of Anderson-Hynes pyeloplasty. BJU Int. 2001; 87(4):287-9. DOI: 10.1046/j.1464-410x.2001.00108.x. View

Clavien P, Sanabria J, Strasberg S . Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery. 1992; 111(5):518-26. View

Tan H . Laparoscopic Anderson-Hynes dismembered pyeloplasty in children. J Urol. 1999; 162(3 Pt 2):1045-7; discussion 1048. DOI: 10.1016/S0022-5347(01)68060-1. View

Peters C . Laparoscopic and robotic approach to genitourinary anomalies in children. Urol Clin North Am. 2004; 31(3):595-605, xi. DOI: 10.1016/j.ucl.2004.04.022. View

Whitaker R . Clinical assessment of pelvic and ureteral function. Urology. 1978; 12(2):146-50. DOI: 10.1016/0090-4295(78)90324-2. View

Peters C, Schlussel R, Retik A . Pediatric laparoscopic dismembered pyeloplasty. J Urol. 1995; 153(6):1962-5. View

10.

El-Ghoneimi A, Farhat W, Bolduc S, Bagli D, McLorie G, Aigrain Y . Laparoscopic dismembered pyeloplasty by a retroperitoneal approach in children. BJU Int. 2003; 92(1):104-8; discussion 108. DOI: 10.1046/j.1464-410x.2003.04266.x. View

11.

Lam P, Wong C, Mulholland T, Campbell J, Kropp B . Pediatric laparoscopic pyeloplasty: 4-year experience. J Endourol. 2008; 21(12):1467-71. DOI: 10.1089/end.2007.9876. View

12.

Satava R . Identification and reduction of surgical error using simulation. Minim Invasive Ther Allied Technol. 2006; 14(4):257-61. DOI: 10.1080/13645700500274112. View

13.

Singh H, Ganpule A, Malhotra V, Manohar T, Muthu V, Desai M . Transperitoneal laparoscopic pyeloplasty in children. J Endourol. 2008; 21(12):1461-6. DOI: 10.1089/end.2007.0023. View

14.

Frede T, Stock C, Renner C, Budair Z, Rassweiler J . Geometry of laparoscopic suturing and knotting techniques. J Endourol. 1999; 13(3):191-8. DOI: 10.1089/end.1999.13.191. View

15.

Metzelder M, Schier F, Petersen C, Truss M, Ure B . Laparoscopic transabdominal pyeloplasty in children is feasible irrespective of age. J Urol. 2006; 175(2):688-91. DOI: 10.1016/S0022-5347(05)00179-5. View

16.

Reddy M, Nerli R, Bashetty R, Ravish I . Laparoscopic dismembered pyeloplasty in children. J Urol. 2005; 174(2):700-2. DOI: 10.1097/01.ju.0000164738.78606.78. View

17.

Kavoussi L, Peters C . Laparoscopic pyeloplasty. J Urol. 1993; 150(6):1891-4. DOI: 10.1016/s0022-5347(17)35926-8. View

18.

Rassweiler J, Teber D, Frede T . Complications of laparoscopic pyeloplasty. World J Urol. 2008; 26(6):539-47. DOI: 10.1007/s00345-008-0266-z. View

19.

Sugiono M, Teber D, Anghel G, Gozen A, Stock C, Hruza M . Assessing the predictive validity and efficacy of a multimodal training programme for laparoscopic radical prostatectomy (LRP). Eur Urol. 2006; 51(5):1332-9. DOI: 10.1016/j.eururo.2006.11.029. View