Experience in performing pyelolithotomy and pyeloplasty in children on day-surgery basis

Abstract

Objectives To evaluate the success of implementing a day-surgery admission policy for pyelolithotomy and pyeloplasty in pediatric cases. Methods A retrospective audit of the urology day-surgery unit records was performed for the period of January 1994 to December 1998. The data included the number of patients and their sex, type of procedures performed, the criteria for case selection, and reported complications that required readmission. The mean patient age was 2.6 years. The decision to perform these procedures on a day-surgery basis was taken after completing preoperative investigations and making the decision for surgery. Several criteria were developed to ensure the success of this application. The parents’ understanding of the day surgery concept was the most important criterion. Pyeloplasties were performed using the Anderson-Hynes technique without stenting and were performed only for patients with an extrarenal pelvis. Pain control was delivered through wound infiltration with long-acting local anesthetic followed by oral non-narcotic analgesics. The immediate follow-up period was 4 to 5 weeks postoperatively, and long-term follow-up data were available for 2.5 to 3 years. Results During the study period, 209 patients underwent surgery for pelviureteral junction obstruction repair and 305 underwent pyelolithotomy for renal stones. Of these children, 85% were discharged the same day, with no reported readmissions during the immediate or delayed follow-up period. Conclusions The results of this study have demonstrated that day surgery can be safely used for children requiring open renal surgical procedures that have more traditionally been performed on an inpatient basis. This has considerable resource implications at little cost in terms of patient morbidity.