Journal Article

Laparoscopic Pyeloplasty, Our Experience of Initial Fifty Two Cases/Laparoskopik Piyeloplasti, Ilk Elli Iki Olgu Deneyimimiz

Khetrapal, Aayush, Yadav, Ram Gopal, Mathur, Rajeev, Bhat, Mahakshit, Sharma, Lokesh, Ahmed, Nisar

2020

Overview

Objective: With the increasing popularity of minimally-invasive surgery, laparoscopic pyeloplasty has become a staple in the armamentarium of urologists. However, the surgery has a steep learning curve and longer operative time. In this study, we aimed to evaluate the results of initial 53 cases of laparoscopic dismembered pyeloplasty in our institute. Materials and Methods: A total 52 of patients with pelvi-ureteric junction (PUJ) obstruction, 30 male and 22 female, with the mean age of 23.5 years were managed by transperitoneal laparoscopic dismembered pyeloplasty. The patients were placed in full lateral position and surgery was done using a minimum of three ports, retrograde pyelography was done in all; initial access was done by using a Veress needle. The ureter was spatulated first, first suture taken and then the PUJ was dismembered to avoid rotation of the ureter. Antegrade DJ stenting was done in all patients and one drain was left in the retroperitoneum after surgery. DJ stent was removed six weeks after surgery. Results: Fifty two patients were managed by dismembered pyeloplasty. Six patients required preoperative urinary diversion. Intrarenal pelvis was seen in seven, crossing vessel in ten, high insertion of ureter in six and associated calculus in five patients. Conversion to open surgery was required in six patients. Initially, the operative time was more than three hours but after sufficient experience of 25 cases, it reduced drastically and in last 28 cases, the mean operative time was 123 minutes, with shortest time reported 97 minutes. Reintervention was required in eight patients and overall success rate was 87%. Conclusion: Laparoscopic pyeloplasty is a safe, minimally-invasive and viable alternative to open pyeloplasty for the management of PUJ obstruction. Keywords: Laparoscopy, Pyeloplasty, PUJ, Obstruction, Dismembered Amac: Minimal invaziv cerrahinin artan popularitesiyle birlikte, Laparoskopik Piyeloplasti urologlarin temel araci haline gelmistir. Buna karsin cerrahi, dik bir ogrenme egrisine ve daha uzun operasyon surelerine sahiptir. Bu calismada, klinigimizde laparoskopik parcalanmis piyeloplasti gerceklestirilen ilk 52 olguya ait sonuclarin degerlendirilmesi amaclanmistir. Gerec ve Yontem: Pelvi-ureterik bileske (PUE) darligina sahip, 30 erkek ve 22 kadin olmak uzere yas ortalamasi 23,5 olan toplam 52 hastaya transperitoneal laparoskopik parcalanmis pyeloplasti uygulandi. Hastalar tam lateral pozisyona yerlestirildi ve en az uc port kullanilarak ameliyat yapildi, hepsinde retrograd piyelografi yapildi; ilk erisimde Veress ignesi kullanildi. Ureter ilk olarak spatule edildi; once sutur alindi ve daha sonra ureterin donusunu onlemek icin PUJ parcalandi. Antegrad DJ stentleme butun hastalara uygulandi ve operasyon sonrasi retroperitonda bir diren birakildi. Operasyondan 6 hafta sonra DJ stent cikarildi. Bulgular: Elli iki hasta parcalanmis piyeloplasti ile tedavi edildi. Alti hastaya ameliyat oncesi uriner diversiyon gerekti. Yedi hastada Intrarenal pelvis, 10 hastada damar gecisi, 6 hastada yuksek yerlesimli ureter ve 5 hastada iliskili kalkul gorulmustur. Alti hastada acik cerrahiye donulmesi gerekmistir. Baslangicta operasyon suresi 3 saatten daha uzunken, 25 olguda olusan yeterli deneyim sonrasi buyuk olcude azalmistir. Son 28 olgunun ortalama operasyon suresi 123 dakika olup bunlar icinde en kisa sure ise 97 dakikadir. Sekiz hastada tekrar mudahale gerekirken, genel basari orani %87'dir. Sonuc: Laparoskopik piyeloplasti; guvenilir, minimal invaziv ve PUE darlik yonetiminde acik piyeloplasti yerine uygulanabilir alternatif bir yontemdir. Anahtar Kelimeler: Laparoskopi, Piyeloplasti, PUE, Darlik, Parcalanmis

• Publisher: Galenos Yayinevi Tic. Ltd
• Subject: Laparoscopy