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Dorsal lumbotomy incision in paediatric pyeloplasty
Author(s) -
Bajpai Minu,
Kumar Arbinder,
Tripathi Madhavi,
Bal Chandrashekhar S.
Publication year - 2004
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-1433.2004.03032.x
Subject(s) - medicine , pyeloplasty , surgery , hydronephrosis , percutaneous nephrostomy , oliguria , renal function , nephrostomy , voiding cystourethrogram , urinary system , percutaneous , vesicoureteral reflux , disease , reflux
Background: The purpose of the present study was to comprehensively assess the results of surgical management of pelvi‐ureteric junction (PUJ) obstruction using lumbotomy as the surgical approach. Methods: Records of 36 consecutive patients with unilateral PUJ obstruction who underwent pyeloplasty in the last 5 years were reviewed retrospectively. The investigations included renal function tests, ultrasound and serial renal diuretic scans. A micturating cystourethrogram was also done whenever indicated. A dismembered pyeloplasty via lumbotomy was the only surgical approach considered. Thirteen patients had a right pyeloplasty while 23 had a left pyeloplasty. Mean age at diagnosis was 57 months in 31 patients while five were antenatally diagnosed (range 1 month−12 years). Age at surgery ranged from 1 month to 12 years with a mean of 59.9 months. Nine children underwent surgery in infancy. Six patients had a preoperative percutaneous nephrostomy (PCN) placement, five for poorly functioning kidneys (less than 10% split renal function) and one for oliguria. Records were reviewed for age at diagnosis, age at surgery, duration of surgery, preoperative and postoperative split renal function. Results: The follow‐up period in the present study ranged from 9 months to 68 months with a mean of 44.9 months. Mean duration of surgery was 78 min of the group as a whole but in PCN patients it was significantly more (100 min vs 71.3 min). Fourteen patients had an improvement in split renal function noticed at 3 and 6 months postoperatively, 17 patients had no change while one patient had a deterioration of split renal function. Four patients had a solitary functioning kidney and in all of these glomerular filtration rate improved postoperatively. Hospital stay was on the average 7.45 days with a range of 6−10 days. However, when a double‐J (D‐J) stent was used across the anastomosis and the uretero‐vesical junction (transrenal D‐J stenting), the mean stay was reduced to 3 days. All patients returned to full oral feeds by postoperative day 1. No incidences of wound related problems were encountered. Conclusions: Pyeloplasty results in predictably good outcome in paediatric PUJ obstruction whenever indicated. The lumbotomy approach avoids muscle cutting, thereby minimizing complications related to wound and assisting with faster recovery. Keeping a double‐J (D‐J) stent across the anastomosis and the uretero‐vesical junction (transrenal D‐J stenting) reduces hospital stay.