The role of laparoscopic surgery for urinary tract reconstruction in infants weighing less than 10kg: A comparison with open surgery

Neheman, Amos; Noh, Paul H.; Piaggio, Lisandro; González, Ricardo

doi:10.1016/j.jpurol.2007.11.012

« Previous Next »Journal of Pediatric Urology
Volume 4, Issue 3 , Pages 192-196, June 2008

The role of laparoscopic surgery for urinary tract reconstruction in infants weighing less than 10kg: A comparison with open surgery

Amos Neheman
- Division of Urology, Department of Surgery, A.I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, USA
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA
Paul H. Noh
- Division of Urology, Department of Surgery, A.I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, USA
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA
Lisandro Piaggio
- Division of Urology, Department of Surgery, A.I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, USA
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA
Ricardo González
- Division of Urology, Department of Surgery, A.I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, USA
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA
- Corresponding author. Division of Urology, Department of Surgery, A.I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, USA. Fax: +1 302 6516410.

Received 25 August 2007; accepted 29 November 2007. published online 17 January 2008.

Abstract

Purpose

To compare the outcome of laparoscopic urinary tract reconstruction (LUTR) in children weighing 10kg or less with a weight-matched cohort undergoing open urinary tract reconstruction surgery (OUTR).

Materials and methods

We conducted a retrospective chart review of patients weighing 10kg or less at the time of surgery who underwent open or laparoscopic pyeloplasty, transuretero-ureterostomy and ipsilateral uretero-ureterostomy between January 2000 and May 2007. The following information was recorded: body weight, age, sex, diagnosis, type of procedure, operative time, estimated blood loss, pre- and postoperative hemoglobin levels, length of hospitalization, length of follow up, use of drains and stents, intraoperative and postoperative analgesic requirement, need for readmission, subsequent procedures, costs, complications and reoperations.

Results

There were 52 patients divided into two groups: LUTR (n=23) and OUTR (n=29). Median weight (range) and follow up was 6.2kg (3.9–10) and 9months and 6.5kg (4.7–9.6) and 31months for LUTR and OUTR, respectively. Mean operative time for LUTR (including cystoscopy and stent placement) was 237min and for OUTR 128min (P<0.01). There were no differences in blood loss, intra- or postoperative analgesic requirement, results or complications. Mean hospitalization time was shorter for LUTR than OUTR (2 and 3days, respectively). There were no differences in hospital costs between the two groups.

Conclusions

Laparoscopic reconstructive surgery for congenital urological anomalies is safe and effective in small infants and can be performed with outcomes comparable to that of open surgery.

Keywords: Laparoscopic surgery, Ureteropelvic junction obstruction, Infants