Clinical Research On Laparoscopic Anderson-hynes Pyeloplasty For Ureteropelvic Junction Obstruction In Infants

Objective To evaluate the feasibility, safety, efficiency and advantageof laparoscopic Anderson-Hynes pyeloplasty vs open pyeloplasty for thetreatment of ureteropelvic junction (UPJ) obstruction in children youngerthan1year; To evaluate the benefits， drawbacks and effect ofpostoperative different pelvis urine drainages;To explore the effect of Co2pneumoperitoneum on acid-base balance of infants body and controlmeasures.Methods①We retrospectly reviewed all infants undergoingtransperitoneal laparoscopic Anderson-Hynes pyeloplasty for UPJobstruction as laparoscopic group (n=48) and all infants undergoing openpyeloplasty for UPJ obstruction as open group(n=53) from July2008to May2013in our hospital. To compare the operative duration, intraoperative andpostoperative complications, postoperative hospital stay, and rate ofrepyeloplasty between laparoscopic group and open group. To follow thechange of AP with ultrasound at regular intervals and analyzed the outcomeof two groups after operation.②During operation all were drainedrandomly with double-J sent and ureteral sent as two groups of internaldrainage and external drainage with simple random sampling methods. The operative duration, intraoperative and postoperative complications,postoperative hospital stay, and rate of repyeloplasty were comparedbetween the internal drainage and external drainage group. the change of APwith ultrasound were followed at regular intervals and analyzed the outcomeof two groups after operation.③To choice the infants younger than12months under the same time with laparoscopic group from open group(n=30). All of two groups were detected with arterial blood gas analysis4hours after operationg. To compare the postoperative hypercapnia incidencebetween laparoscopic group and open group.Results①In laparoscopic group forty-seven infants completedtransperitoneal laparoscopic Anderson-Hynes pyeloplasty except one caseof intraoperative convertion to open surgery limited to abdominal workingspace because of intestine dilatation. Median operative time of laparoscopicgroup(84.6min) was obviously longer than open group(62.3min),(Р﹤0.05).No intraoperative and postoperative complications about intestinal tractwere recorded in laparoscopic and open group. The complicationsprobability of two groups had no significant difference,23.4％and24.5％,respectively(Р＞0.05). The hospital stay of laparoscopic group(8.9d)significantly shorter than the open group(11.9d)(Р﹤0.05). Statisticalanalysis indicated the outcome of two groups had no difference. one case ofreoperation in open group was reported because of anastomotic stenosis.②In laparoscopic group, Median operative time of interal and externaldrainage groups had no significant difference,82.8min and86.4min,respectively(Р＞0.05). No intraoperative complications aboutpneumoperitoneum and intestinal tract and other visceral organs were recorded in internal and external drainage groups. in two groups in elevencases(23.4％) of postoperative complications reported, of which seven(14.9％) belonged to claveinⅠand four(8.5％) belonged to claveinⅡ. The sevenclaveinⅠcases contained3cases of anastomotic obstructions transiently and1case of drainage tube jam in the external drainage group, as well as1caseof urinary extravasation,1case of gross hematuria, and1case of incisionalhernia of omental cured after heteropathy treatment in the interal drainagegroup. The four claveinⅡ cases were all found in the interal drainage group,with urinary tract infections accompanied by fever, and were cured afteranti-infection treatment. The hospital stay of external drainage group(10.6d)significantly longer than the intrernal drainage group(7.2d)(Р﹤0.05).Median follow-up was14months (3-24). Statistical analysis demonstratedthe outcome of two groups had no difference. No case of reoperation wasreported.③The incident of postoperative hypercapnia of laparoscopicgroup was obviously higher than that of open group,(Р﹤0.05).Concliution Laparoscopic Anderson-Hynes pyeloplasty is a safe,reliable, and efficient procedure with an excellent outcome, and analternative to open pyeloplasty with shorter hospital stay, fasterpostoperative recover, more cosmetic results, and minimally invasiveadvantage of anatomy, but longer operation time in infants with UPJobstruction. The operative way of ureteral sent is superior to the way ofdouble-J sent. Co2pneumoperitoneum of laparoscopic surgery is theimportant cause of infant postoperative hypercapnia, and has adverse effecton infant physiological environment.