Analysis And Management Of Complications In Laparoscopic Pyeloplasty For Children

Background and purposeUreteropelvic Junction Obstruction(UPJO)is common cause of neonatal hydronephrosis.Untreated disease will develop into renal failure.Reconstruction of the anatomical structure of the renal pelvis and ureter is the gold standard to delay progression of the disease and improve prognosis of patients.At present,laparoscopic pyeloplasty(LP)has become one of the main methods for the treatment of patients with UPJO.The study aim to describe and analyze a single surgical team’s experience with intraoperative and postoperative complications arising from laparoscopic pyeloplasty(LP)procedure in the treatment of patients UPJO.MethodsA retrospective analysis of clinical data of 243 cases of UPJO patients treated with LP in the Department of Pediatric Surgery of the First Affiliated Hospital of Zhengzhou University from January 2015 to December 2018.Among them,there were 207 males and 36 females;age(<12 months old 46 cases,≥12 months old 197 cases);body weight(55 cases<10 kg,188 cases≥10 kg),left side 206 cases,right side 37 cases.According to the postoperative complications,the children were divided into a complication group(34 cases)and a non-complication group(209 cases)for comparative analysis,looking for risk factors for postoperative complications,and establishing a clinical model to predict LP in children The risk of postoperative complications,and discuss the treatment of postoperative complications.ResultsThe incidence of postoperative complications in this group was 14.0%(34/243).According to the Clavien-Dindo grading system,there were 12 cases(4.9%)with large postoperative drainage and delayed removal of the drainage tube,4 cases(1.6%)with postoperative urinary tract infection and cephalosporins,and 9 cases(3.7%)with grade III a developed abdominal pain,nausea and vomiting after removal of the drainage tube.Abdominal and urinary color ultrasonography showed peritoneal effusion and perirenal effusion.Ultrasound-guided puncture and catheterization of the lower abdomen and renal pelvis were performed.Abdominal pain occurred in 2 cases when the drainage tube was not removed.Considering the poor drainage of the drainage tube,the symptoms were relieved after adjusting the position of the drainage tube under the guidance of ultrasound.After the double J tube was removed,2 cases had peritoneal effusion and were given pyelostomy and abdominal puncture and drainage;grade III b 9 cases(3.7%),of which 6 cases were diagnosed as re-obstruction and underwent operation again.When the DmurJ tube was removed after operation,the edema of the end of the ureter was found in the cystoscope in 2 cases,and the Dmurj tube did not enter the bladder.The new Dmurj tube was replaced,and the Dmurj tube was removed again after 6 weeks.After operation,the intestinal canal was dilated through the original drainage tube in 1 case,and the intestinal tube was returned under general anesthesia immediately.Preoperative renal function was less than 40%in the complication group 65.4%(17 cases/26 cases),≥40%in 34.6%(9 cases/26 cases),and non-complication group renal function was less than 40%accounted for 26.4%(37cases/140 cases),≥40%accounted for 73.6%(103 cases/140 cases),the difference between the renal function groups was statistically significant(x2=15.160,P<0.001);the anastomotic tension in the complications group accounted for 50%(17 cases/34 cases),no account 79.4%(17 cases/26 cases),non-complication group accounted for 20.6%(43 cases/209 cases),no account for 79.4%(166 cases/209 cases),the difference was statistically significant(x2=13.617,P<0.001).Multivariate Logistic regression analysis showed that renal function(OR=5.17,95%CI:1.88～14.21)and anastomotic tension(OR=14.34,95%CI:4.74～43.41)were independent risk factors for complications of LP.The AUC of the two indexes to predict the postoperative complications of LP were 0.70 and 0.72 respectively,and the AUC of the combination of the two indexes was 0.81.Conclusion(1)Although laparoscopic pyeloplasty for the treatment of patients with UPJO is a safe and reliable treatment with a high surgical success rate,there is still a 14%complication rate.(2)Preoperative renal function and intraoperative anastomotic tension are independent risk factors for complications after laparoscopic pyeloplasty.(3)The combined analysis of preoperative renal function and intraoperative anastomotic tension can better predict the incidence of postoperative complications.