Laparoscopic pyeloplasty: Which approach? Single center experience

Year 2016, Volume: 11 Issue: 2, 24 - 31, 01.05.2016

Selçuk Şahin Mustafa Gürkan Yenice Nevzat Can Şener Volkan Tuğcu Kamil Gökhan Şeker

Abstract

Objective: The aim of this study is to retrospectively examine the data of 112 patients who had laparoscopic transperitoneal pyeloplasty LTPP or laparoscopic retroperitoneal pyeloplasty LRPP operations at our clinic due to primary ureteropelvic junction obstruction. Material and Methods: The data from patients who had standard laparoscopic pyeloplasty between January 2007 and January 2015 with a primary UPJ obstruction were examined. Comparative data from transperitoneal and retroperitoneal laparoscopic approaches were statistically analyzed. Results: Given the demographic and clinical characteristics of the patients 74 patients with transperitoneal, 38 patients with retroperitoneal surgery , there were no significant differences between the two groups. Mean operation duration was 149.52 minutes in the transperitoneal approach and 187.76 minutes in the retroperitoneal approach. Intracorporeal suturing was 66.4 minutes on average in the transperitoneal approach and 84.21 minutes in the retroperitoneal approach. The visual analogue scores, which were evaluated on postoperative days 1 and 2, the need for analgesics, and the length of stay in hospital were found to be higher in the group with LTPP compared to the LRPP group. One patient in each group had to undergo conversion to open surgery. Conclusion: The transperitoneal approach was found to be more advantageous than the retroperitoneal approach due to larger working area for the surgeon, easier and quicker intracorporeal suturing, easier control in the presence of aberrant blood vessels. On the other hand, the retroperitoneal approach was found to be superior to the transperitoneal approach with respect to gastrointestinal system findings, postoperative pain and shortness of the hospital stay duration. High rates of success were achieved in both groups in long-term follow-ups.

Keywords

Pyeloplasty , transperitoneal , retroperitoneal , primary ureteropelvic junction obstruction

Laparoskopik piyeloplasti: Hangi yaklaşım? Tek merkez deneyimi

Abstract

Amaç: Bu çalışmanın amacı, kliniğimizde primer üreteropelvik bileşke darlığı nedeniyle laparoskopik transperitoneal piyeloplasti LTPP ve laparoskopik retroperitoneal piyeloplasti LRPP laparoscopic retroperitoneal pyeloplasty LRPP operasyonu yapılan 112 hastanın verilerini geriye operations at our clinic due to primary ureteropeldönük incelemek ve deneyimimizi sunmaktır. Materyal ve Metod: Ocak 2007 ile Ocak 2015 tarihleri arasında primer üreteropelvik bileşke who had standard laparoscopic pyeloplasty between darlığı tanısı ile standart laparoskopik piyeloplasti January 2007 and January 2015 with a primary UPJ operasyonu yapılan hastaların verileri incelendi. obstruction were examined. Comparative data from Transperitoneal ve retroperitoneal laparoskopik transperitoneal and retroperitoneal laparoscopic yaklaşım verileri karşılaştırılmalı istatistiksel olarak analiz edildi.Bulgular: Hastaların 74 hasta transperitoneal, 38 hasta retroperitoneal demografik ve transperitoneal, 38 patients with retroperitoneal klinik özelliklerine bakıldığında iki grup arasınsurgery , there were no significant differences beda herhangi bir anlamlı farklılık yoktu. Ortalama operasyon süresi transperitoneal yaklaşımda 149.52 minutes in the transperitoneal approach and 149.52 dk, retroperitoneal yaklaşımda ise 187,76 187.76 minutes in the retroperitoneal approach. Indk idi. İntrakorporeal sütürasyon transperitoneal yaklaşımda ortalama 66.4 dk, retroperitoneal in the transperitoneal approach and 84.21 minutes yaklaşımda ise 84.21 dk idi. Postoperatif 1. ve 2. in the retroperitoneal approach. The visual anagünde değerlendirilen visuel analog skoru VAS , analjezik gereksinimi, hastanede kalış süresi LTPP yapılan grupta LRPP yapılan gruba oranla yüksek bulundu. Hiçbir hastada Clavien 4-5 derece komplikasyon görülmedi. Her iki grupta da 1 hastada One patient in each group had to undergo converoperasyon açığa geçilerek tamamlandı. sion to open surgery.Sonuç: Transperitoneal yaklaşım cerrah açısından daha geniş çalışma alanı, daha kolay ve kısa sürede intrakorporeal sütürasyon, aberran damar varlığında daha kolay kontrol sağlaması, kısa operasyon süresi ile retroperitoneal yaklaşıma göre daha avantajlı olarak görüldü. Retroperitoneal yaklaşım ise gastrointestinal sistem bulguları, postoperatif ağrı ve kısa hastanede kalış süresi bakımından transperitoneal yaklaşıma üstün bulundu. Uzun dönem takiplerde her iki grupta da yüksek başarı oranları sağlandı

Keywords

Piyeloplasti , Transperitoneal , Retroperitoneal , Primer Üreteropelvik bileşke darlığı

References

• O’Reilly PH, Brooman PJ, Mak S, et al. The long-term re- sults of Anderson Hynes pyeloplasty. BJU Int 2001;87:287- 9.
• Schuessler WW, Grune MT, Tecuanhuey LV, et al. Lapa- roscopic dismembered pyeloplasty. J Urol 1993;150:1795– 1799.
• Janetschek G, Peschel R, Altarac S, et al. Laparoscopic and retroperitoneoscopic repair of ureteropelvic junction obs- truction.Urology 1996;47:311–316.
• Singh V, Sinha RJ, Gupta DK et al. Prospective randomized comparison between transperitoneal laparoscopic pyelop- lasty and retroperitoneoscopic pyeloplasty for primary ure- teropelvic junction obstruction JSLS 2014;18.
• Shoma AM, El Nahas AR, Bazeed MA. Laparoscopic pye- loplasty. A prospective randomized comparison between the transperitoneal approach and retroperitoneoscopy. J Urol 2007;178:2020–4.
• Rassweiler JJ, Teber D, Frede T. Complications of laparos- copic pyeloplasty. World J Urol 2008;26:539 –547.
• Devenport K, Minervini A, Timoney FX Jr. Our experience with retroperitoneal and transperitoneal laparoscopic pye- loplasty for pelvi-ureteric junction obstruction. Eur Urol 2005; 48:973–977.
• Inagaki T, Rha KH, Ong AM, et al. Laparoscopic pyelop- lasty: current status. BJU Int 2005;95:102– 105.
• Adeyoju AB, Hrouda D, Gill IS. Laparoscopic pyeloplasty: the first decade. BJU Int 2004;94:264 –267.
• Clayman RV, Kavoussi LR, Soper NJ, et al. Laparoscopic nephrectomy: initial case report. J Urol 1991;146:278-82.
• Bryant RJ, Craig E, Oakley N. Laparoscopic pyeloplasty: the retroperitoneal approach is suitable for establishing a de novo practice. J Postgrad Med 2008;54:263-267.
• Moon DA, El-Shazly MA, Chang CM, et al. Laparosco- pic pyeloplasty: evolution of a new gold standard. Urology 2006;67:932-936.
• Hemal AK, Goel R, Goel A. Cost effective laparoscopic pye- loplasty: single center experience. Int J Urol 2003;10:563-8.
• Soulie M, Salomon L, Patard J-J et al. Extraperitoneal lapa- roscopic pyeloplasty: a multicenter study of 55 procedures. J. Urol 2001; 166: 48–50.
• Wu Y, Dong Q, Han P, et al. Meta-analysis of transperito- neal versus retroperitoneal approaches of laparoscopic pye- loplasty for ureteropelvic junction obstruction. J Laparoen- dosc Adv Surg Tech A 2012;22:658–62.
• Canon SJ, Jayanthi VR, Lowe GJ. Which is better— retro- peritoneoscopic or laparoscopic dismembered pyeloplasty in children? J Urol 2007;178:1791–1795.
• Zhu H, Shen C, Li X, et al. Laparo-scopic pyeloplasty: a comparison between the transperitoneal and retrope- ritoneal approach during the learning curve. Urol Int 2013;90:130-5.
• Hafron J, Kaouk JH. Technical advances in urological la- paroscopic surgery. Expert Rev Med Devices 2008;5: 145– 151.
• Cestari A, Buffi NM, Lista G, et al. Retroperito- neal and transperitoneal robot-assisted pyelop- lasty in adults: techniques and results. Eur Urol 2010;58:711- 8.
• Zeltser IS, Liu JB, Bagley DH. The incidence of crossing ves- sels in patients with normal ureteropelvic junction exami- ned with endoluminal ultrasound. J Urol 2004;172:2304–7.
• Rehman J, Landman J, Sundaram C, et al. Missed anterior crossing vessels during open retroperitoneal pyeloplasty: laparoscopic transperitoneal discovery and repair. J. Urol 2001; 166: 593–6.
• Husmann DA, Milliner DS, Segura JW. Ureteropelvic junc- tion obstruction with a simultaneous renal calculus: long term followup. J Urol 1995;153:1399 –1402.
• Arumainayagam N, Minervini A, Davenport K, et al. An- tegrade versus retrograde stenting in laparoscopic pyelop- lasty. J Endourol 2008;22:671-4.
• Eden CG, Cahill D, Allen JD. Laparoscopic dismembered pyeloplasty: 50 consecutive cases. BJU Int 2001;88:526-31.
• Jarrett TW, Chan DY, Charambura TC, et al. Laparoscopic pyeloplasty: the first 100 cases. J Urol 2002;167:1253-6.
• Gargouri MM, Nouira Y, Kallel Y, et al. The long-term re- sults of laparoscopic retroperitoneal pyeloplasty in adults. Arab J Urol 2013 ;11:411-4.
• A. Castillo, W. Cabrera, E. Aleman, et al. Laparoscopic pye- loplasty: Technique and results in 80 consecutive patients. Actas Urol Esp 2014;38:103-108.