Dorsal Lumbotomy Approach for Pediatric Dismembered Pyeloplasty

Pankaj Halder,Rammohan Shukla,Rajarshi Kumar,Kartik Chandra Mandal,Biswanath Mukhopadhyay,Lopamudra Mishra

doi:10.21767/2574-2817.100007

Pankaj Halder, Rammohan Shukla + Show 4 more

Open Access

https://doi.org/10.21767/2574-2817.100007

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Abstract

Aim: Recently, the posterior lumbotomy approach has become widely popular for pediatric pyeloplasty. The current study reassesses the approach for pediatric dismembered pyeloplasty considering its advantages and limitations. Materials and methods: We conducted a prospective study with 84 cases of hydronephrosis due to ureteropelvic junction obstruction, over a period of five years. We excluded the cases of hydronephrosis in ectopic or rotated kidney and cases of revision surgery (redo pyeloplasty). All patients were properly evaluated before subjecting them to the surgery. All patients underwent dismembered pyeloplasty through the posterior vertical lumbotomy incision. A transanastomotic double J stent was placed in all cases which were removed within 4-6 weeks of pyeloplasty. Perioperative findings were recorded, tabulated and analyzed carefully. The patients were followed up for 3 years. Results: The mean age of the patient at operation was 43 months. The average length of incision was 3-4 cm and mean operating time was 50.6 minutes. There was no difficulty in gaining the access to the pathology in any of the patients. Intra-operatively, we failed to clear out the distal (ureterovesical junction) obstruction in 4 patients where a nephrostomy was done in addition to pyeloplasty. All patients recovered from anesthesia uneventfully and returned to full oral feeds by 1st postoperative day. There were no major complications related to surgery. The mean duration of hospital stay was 3.9 days. Redo pyeloplasty was needed in two cases. There were no wound related major complications. Conclusion: The dorsal lumbotomy approach for pediatric pyeloplasty is advantageous in the form of small incision, easy and quick access to the pathology, short operating time, early recovery to normal activity and short hospital stay. It could also be practiced in other urological surgeries provided the cases are selected carefully.

Highlights

Hydronephrosis (HDN) is one of the common correctable urological conditions in pediatric population
We performed the preoperative investigations in the form of blood hemogram, urine routine and culture, ultrasonography of kidney ureter and bladder (USG KUB) for renal biometry, Diuretic isotope renogram with diethyl tri-amino Penta acetic acid (DTPA) and micturating cystourethrogram (MCUG)
Under general anesthesia patient is placed in prone position and a vertical incision is made for dorsal lumbotomy approach (Figure 1)

Summary

Introduction

Hydronephrosis (HDN) is one of the common correctable urological conditions in pediatric population. Ureteropelvic junction obstruction (UPJO) is the most common cause of HDN in children. The choice of surgery is dismembered pyeloplasty that can be done by anterior subcostal, flank approach or dorsal lumbotomy approach [1,2]. The posterior vertical lumbotomy incision provides an easy and quick access to UPJ. This technique does not involve any muscle cutting and there is minimal post-operative discomfort, negligible wound related complications, faster recovery and a cosmetically well-positioned scar [3,4]. We have conducted this study to reassess the pros and cons of the posterior vertical lumbotomy incision (PVLI) for pediatric pyeloplasty

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