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One stage laparoscopic hemi-nephroureterectomy with excision of ureterocele and ureteric reimplantation: long term outcome
S78
ESPU Meeting 2007
# S15-5 (V)
RETROPERITONEOSCOPIC VERSUS OPEN DISMEMBERED PYELOPLASTY FOR URETEROPLEVIC JUNCTION OBSTRUCTION IN CHILDREN Jean-Stephane VALLA, Nicolas SAUTOT-VIAL, Fabio BERETTA, Ricardo GUANA, Thomas GELAS, ´E and Henry STEYAERT Xavier CARPENTIER, Regine LECULE hopital lenval, Nice, FRANCE
PURPOSE
RESULTS
New techniques should be compared with the gold standard of classical open surgery to confirm their true effectiveness and potential advantages.
The respective indication for each technique has changed during this 7 years period: for the first 20 patients open surgery was used in 80% of cases and for the last 20 patients minimally invasive surgery was used in 90%. Operative time was longer for the retroperitoneal laparoscopic group (155 min versus 98); mean hospital stay was nearly similar (4,5 days versus 5,5). No intraoperative complications occurred in either group. The incidence of post operative complications, mainly urine leakage, was 11% in the open group (of which 4 cases needed another general anaesthetic for ureteral catheter placement) and 17% in the laparoscopic group (of which 6 patients needed a new general anaesthetic). Mean follow up was 41 months and 16 months in the open and
MATERIAL AND METHODS In a retrospective review between 1999 and 2005, 45 patients with a mean age of 22 months (range 1 to 168) who underwent lumbotomy pyeloplasty were compared to 45 patients with a mean age of 71 months (range 4 to 172) who underwent retroperitoneoscopic pyeloplasty. All the patients were operated by the same two surgerons (JSV-HS) well trained in laparoscopic techniques. We analysed operative time, hospital stay and results.
laparoscopy group, respectively; 2 patients in the open group and 1 patient in the laparoscopic group needed to be reoperated on later for restenosis (success rate 95,5% versus 97,7%).
CONCLUSIONS Retroperitoneoscopic dismembered pyeloplasty in children remains a difficult operation even after a learning curve ; however this technique is as safe and effective as open pyeloplasty; it is feasable after 3 months of age; the main advantage in our study is cosmetic; the others potential advantages (less pain, fast recovery) seems more clear in adolescents.
# S15-6 (O)
ONE STAGE LAPAROSCOPIC HEMI-NEPHROURETERECTOMY WITH EXCISION OF URETEROCELE AND URETERIC REIMPLANTATION: LONG TERM OUTCOME Chung Kwong YEUNG, Biji SREEDHAR, Atul THAKRE and Jennifer Dart Yin SIHOE Chinese University of Hong Kong, Surgery, Shatin, HONG KONG
PURPOSE To evaluate the long term outcome after the one-stage laparoscopic heminephroureterectomy with simultaneous excision of ureterocele, and reimplantation of the normal moiety ureter.
MATERIAL AND METHODS Nineteen patients (M/F: 3/16) underwent the procedure. Mean age at surgery was 1.81years (range 1m - 7.24 years). All patients had a duplex system with a nonfunctioning upper moiety and large complicating ectopic caecoureterocoeles which persisted despite previous cystoscopic incision. VUR occurred in 8 patients (3 bilateral). All patients underwent the one - stage laparoscopic
procedure via a transperitonial route with endoscopic upper pole heminephrectomy with extravesical excision of the ureterocele, and reimplantation of the lower moiety ureter. All patients were regularly followed every 3 months and repeated radiological assessments including US, VCUG and DMSA were done at 12 months and then at yearly interval afterwards. Complete resolution of the VUR was confirmed based on negative findings on follow up VCUG.
RESULTS The procedure was successful in all patients and no procedure-related complications were observed. Mean follow up was 4.45 years (range.1.1 e 8 yrs). None of the patients in this series showed functional loss in the remaining ipsilateral moiety. Follow-up cystogram
showed complete resolution of VUR in all 8 patients (100 %). Two patients developed UTI during the follow up period and none of them developed a new renal scar. Cosmetic results were excellent in all patients and no long-term complications have been encountered so far.
CONCLUSIONS Our experience demonstrates that this radical definitive surgery can be safely and effectively performed in a single stage laparoscopic procedure. The procedure minimizes the hazards of traditional open surgical reconstruction. Furthermore, the long-term successful outcome in our series establishes this unique procedure as safe and effective in treating infants with renal duplication associated with ectopic ureteroceles.
ESPU Meeting 2007
# S15-5 (V)
RETROPERITONEOSCOPIC VERSUS OPEN DISMEMBERED PYELOPLASTY FOR URETEROPLEVIC JUNCTION OBSTRUCTION IN CHILDREN Jean-Stephane VALLA, Nicolas SAUTOT-VIAL, Fabio BERETTA, Ricardo GUANA, Thomas GELAS, ´E and Henry STEYAERT Xavier CARPENTIER, Regine LECULE hopital lenval, Nice, FRANCE
PURPOSE
RESULTS
New techniques should be compared with the gold standard of classical open surgery to confirm their true effectiveness and potential advantages.
The respective indication for each technique has changed during this 7 years period: for the first 20 patients open surgery was used in 80% of cases and for the last 20 patients minimally invasive surgery was used in 90%. Operative time was longer for the retroperitoneal laparoscopic group (155 min versus 98); mean hospital stay was nearly similar (4,5 days versus 5,5). No intraoperative complications occurred in either group. The incidence of post operative complications, mainly urine leakage, was 11% in the open group (of which 4 cases needed another general anaesthetic for ureteral catheter placement) and 17% in the laparoscopic group (of which 6 patients needed a new general anaesthetic). Mean follow up was 41 months and 16 months in the open and
MATERIAL AND METHODS In a retrospective review between 1999 and 2005, 45 patients with a mean age of 22 months (range 1 to 168) who underwent lumbotomy pyeloplasty were compared to 45 patients with a mean age of 71 months (range 4 to 172) who underwent retroperitoneoscopic pyeloplasty. All the patients were operated by the same two surgerons (JSV-HS) well trained in laparoscopic techniques. We analysed operative time, hospital stay and results.
laparoscopy group, respectively; 2 patients in the open group and 1 patient in the laparoscopic group needed to be reoperated on later for restenosis (success rate 95,5% versus 97,7%).
CONCLUSIONS Retroperitoneoscopic dismembered pyeloplasty in children remains a difficult operation even after a learning curve ; however this technique is as safe and effective as open pyeloplasty; it is feasable after 3 months of age; the main advantage in our study is cosmetic; the others potential advantages (less pain, fast recovery) seems more clear in adolescents.
# S15-6 (O)
ONE STAGE LAPAROSCOPIC HEMI-NEPHROURETERECTOMY WITH EXCISION OF URETEROCELE AND URETERIC REIMPLANTATION: LONG TERM OUTCOME Chung Kwong YEUNG, Biji SREEDHAR, Atul THAKRE and Jennifer Dart Yin SIHOE Chinese University of Hong Kong, Surgery, Shatin, HONG KONG
PURPOSE To evaluate the long term outcome after the one-stage laparoscopic heminephroureterectomy with simultaneous excision of ureterocele, and reimplantation of the normal moiety ureter.
MATERIAL AND METHODS Nineteen patients (M/F: 3/16) underwent the procedure. Mean age at surgery was 1.81years (range 1m - 7.24 years). All patients had a duplex system with a nonfunctioning upper moiety and large complicating ectopic caecoureterocoeles which persisted despite previous cystoscopic incision. VUR occurred in 8 patients (3 bilateral). All patients underwent the one - stage laparoscopic
procedure via a transperitonial route with endoscopic upper pole heminephrectomy with extravesical excision of the ureterocele, and reimplantation of the lower moiety ureter. All patients were regularly followed every 3 months and repeated radiological assessments including US, VCUG and DMSA were done at 12 months and then at yearly interval afterwards. Complete resolution of the VUR was confirmed based on negative findings on follow up VCUG.
RESULTS The procedure was successful in all patients and no procedure-related complications were observed. Mean follow up was 4.45 years (range.1.1 e 8 yrs). None of the patients in this series showed functional loss in the remaining ipsilateral moiety. Follow-up cystogram
showed complete resolution of VUR in all 8 patients (100 %). Two patients developed UTI during the follow up period and none of them developed a new renal scar. Cosmetic results were excellent in all patients and no long-term complications have been encountered so far.
CONCLUSIONS Our experience demonstrates that this radical definitive surgery can be safely and effectively performed in a single stage laparoscopic procedure. The procedure minimizes the hazards of traditional open surgical reconstruction. Furthermore, the long-term successful outcome in our series establishes this unique procedure as safe and effective in treating infants with renal duplication associated with ectopic ureteroceles.