Clinical Experience Of Modified Minimally Invasive Incision Assisted Laparoscopic Pyeloplasty In Children With UPJO

Objective:Comparison of the clinical experience of modified minimally invasive incision assisted laparoscopic pyeloplasty,laparoscopic pyeloplasty and lumbar mini incision pyeloplasty in the treatment of children with UPJO(ureteropelvic junction obstruction).Methods:The medical records of all patients with UPJO,who underwent modified minimally invasive incision assisted laparoscopic pyeloplasty,laparoscopic pyeloplasty and lumbar mini incision pyeloplasty were retrospectively reviewed.All children were divided into minimally invasive incision assisted laparoscopic pyeloplasty,laparoscopic pyeloplasty and lumbar mini incision pyeloplasty group according to different operation methods.We collected data such as patients’ demographics,intra-operative details.Postoperative follow-up was performed with renal US at 1,3,6 months after surgery,and double-J tubes were removed at 4～6 weeks after surgery.Results:There was no statistical difference in BMI,age,degree of hydronephrosis and other general records among the three groups.In this study,all patients underwent surgery successfully without conversions to other operation methods.Significant differences existed between modified minimally incision assisted laparoscopic pyeloplasty group and other groups in operation lasting time(P<0.001),however,there was no significant differences between modified minimally incision assisted laparoscopic pyeloplasty group and lumbar mini incision pyeloplasty group(P=1.000).Significant differences existed between laparoscopic pyeloplasty group and other groups in intraoperative blood(P<0.001),while there was no clinical significance;There was significant differences between laparoscopic pyeloplasty group and other groups in the lasting time of hematuria after surgery(P<0.001),while there was no significance differences between lumbar mini incision pyeloplasty group and modified minimally incision assisted laparoscopic pyeloplasty group(P=0.121).There was no statistical difference among three groups in perirenal drainage;modified minimally incision assisted laparoscopic pyeloplasty group has the shorter time of drainage tube intubation compared to the other groups.Lumbar mini incision pyeloplasty group has longer hospitalization times between the other groups and there was significant differences(P<0.001).As for postoperative complications,we recorded urinary leakage of ureteropelvic junction in one laparoscopic pyeloplasty patient(3.3%)and in one lumbar mini incision pyeloplasty patient(3.2%),however there was no statistical difference in postoperative complications among the three groups.The success rate of the three groups all were 100%.Conclusion:According to our study,modified minimally incision assisted laparoscopic pyeloplasty has advantages such as shorter operation time,less intraoperative blood loss,shorter duration of drainage tube indwelling which can reduce the pain of children and shorter hospitalization times.Considering the long learning curve of laparoscopic pyeloplasty and the immature laparoscopic skills of young surgeons and lumbar mini incision pyeloplasty stable operation effect,but large trauma,modified minimally incision assisted laparoscopic pyeloplasty should be indicated in patients.