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Objectives: Ureteric stent insertion during laparoscopic pyeloplasty is the common practice for the reconstruction of ureteropelvic junction obstruction (UPJO). The long and hard learning curve of the method leads still controversy among surgeons. The utility of extracorporeal stent insertion in terms of shortening the length of operation time will be discussed in this study. Methods: A total of 36 children who underwent pyeloplasty for UPJO were evaluated retrospectively. Indications for pyeloplasty were: Obstruction findings in renal scintigraphy, progressive kidney function loss, increasing in anteroposterior pelvis diameter in renal ultrasonography, and current clinical symptoms (febrile urinary tract infection and flank pain). Extracorporeal stent insertion procedure was performed as the following order: Ureteropelvic area and ureter were visualized transperitoneal by three trochars, and UPJO was excised. Thereafter, the ureter is taken out of the skin from pelvic trochar entrance and is spatulated. JJ stent is placed into the ureter. Following this move, the ureter is taken into the intra-abdominal area and first ureteropelvic suture is performed intra-abdominally. Results: Thirteen of patients were girls and 23 were boys. Open surgery was applied for 15 patients (Group 1) and laparoscopic pyeloplasty (Group 2) to 21 patients. In Group 2, JJ stent was placed intracorporeally for six patients (Group 2a) and extracorporeally for the other 15 patients (Group 2b). The average age in Group 1 was 49.2±52 months; it was 86±29 months in Group 2a and 144±52 months in Group 2b, and the significant difference was present (p<0.001). There was statistically significant difference between Group 1 and Group 2 regarding with mean hospital stay (40 h in Group 1 and 42 h in Group 2; p=0.001). Post-operative JJ stent removal time was 58.8 days in Group 1 and 52.89 days in Group 2. In Group 2b patients, placing the stent extracorporeally took a significantly shorter operation time and the difference between the operation times of the groups (2a [192 min±3.76] and 2b [135 min±2.6] [p<0.001]) was statistically significant. No statistical difference was found between Group 1 (9.87±5.5 mm) and Group 2 (12.91±5.3 mm) in terms of renal anteroposterior diameters in the control ultrasonographic evaluation at the post-operative 2nd year (p=0.23). There was no difference between the two groups as a result of the evaluation of renal functions by scintigraphy at the post-operative 1st year (Group 1: 3.95±2%; and Group 2: 0.78±5.3%). Conclusion: According to the consequences in this study, extracorporeally ureteric stent insertion during laparoscopic pyeloplasty shortens the length of operation duration so that extracorporeal insertion might be preferred in cases where it is difficult to place the stent during laparoscopic pyeloplasty.
Purpose: Stent inserting produced during laparoscopic pyeloplasty is a common application for the surgical treatment of ureteropelvial compound thinity. The learning curve, which is long and difficult in the method, still leads to controversy among surgeons. The contribution of extracorporeal stent placement to the shortening of the surgery time will be discussed in this study. Method: 36 children who were applied pyeloplasty due to ureteropelvik compound obstruction were examined as retrospective. Pyeloplasty indications include: symptoms of obstruction in the renal sintigraphy, progressive renal function loss, anteroposterior pelvis diameter increase in the renal ultrasound, clinical symptoms (inflammatory urinary tract infection and side pain). The extracorporeal stent placement process was done according to the order: the ureteropelvik area and the producer was disqueated transperitoneally with 3 trocar, the ureteropelvik component density was exhausted. Later, the producer pelvic trocar was taken out of the entrance place and spatulated. JJ stent was placed in the production as extracorporeal. Following the producer was taken into the west and the first ureteropelvik milk was entered into the west. Results: 13 of the patients were girls, 23 were men. Five-five patients (group 1) were open surgery, 21 patients were laparoscopic pyeloplasty (group 2) was administered. In Group 2, JJ stent was placed in 6 patients (Group 2a) intrakorporeal and other 15 patients (Group 2b) extracorporeal. The age average was 49.2±52 months in group 1; 86±29 months in group 2a and 144±52 months in group 2b and a significant difference was evident (p<0.001). There was a significant difference in the average duration of stay in the hospital in patients with laparoscopic and open surgery (40 hours in group 1; 42 hours in group 2; p=0.001). The postoperative JJ stent removal time was 58.8 days in group 1 and 52.89 days in group 2. The duration of the operation was significantly short among patients in group 2 placed as stentin extracorporal (2a (192 minutes ± 3.76) and 2b (135 minutes ± 2.6) (p < 0.001)). In the postoperative 2 year of control, there was no statistical difference between the group 1 (9.87±5.5 mm) and the group 2 (12.91±5.3 mm) in terms of the renal anteroposterior diameter in the ultrasound assessment (p=0.23). There was no difference between the two groups as a result of the postoperative 1 year syntigraphy assessment of kidney functions (group 1: 3.95 ± 2; group 2: 0.78 ± 5.3). The result: According to our study, the placement of stent in the producer as extracorporal during laparoscopic pyeloplasty significantly cuts the duration of the procedure and in cases where the placement of stent is difficult, it is preferable to be placed as extracorporal. (SETB-2020-06-106)
Alan : Sağlık Bilimleri
Dergi Türü : Ulusal
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