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29
th
CONGRESS OF THE ESPU
S14: LAPAROSCOPY / ROBOTICS
Moderators: Rafal Chrzan (Poland), Aseem Shukla (USA)
ESPU Meeting on Friday 13, April 2018, 08:52–09:46
08:52–08:55
S14-1 (PP)
★
FEASIBILITY AND BENEFITS OF THE RETROPERITONEAL
LAPAROSCOPY IN THE TREATMENT OF URETEROPELVIC
JUNCTION OBSTRUCTION IN CHILDREN UNDER ONE
YEAR, COMPARED TO OPEN SURGERY
Anthony KALLAS-CHEMALY, Matthieu PEYCELON, Liza ALI, Christine GRAPIN-
DAGORNO, Elisabeth CARRICABURU, Pascale PHILIPPE-CHOMETTE, Goharig
ENEZIAN, Annabel PAYE-JAOUEN and Alaa EL-GHONEIMI
Robert-Debré University Hospital, AP-HP; Université Paris Diderot, Sorbonne Paris Cité, Paediatric Urology, National
reference center of rare urinary tract malformations (MARVU), Paris, FRANCE
PURPOSE
The advantage and feasibility of laparoscopy in the treatment of ureteropelvic junction obstruction
(UJPO) remains controversial in children under twelve months of age. The aim of this study was to
evaluate the feasibility and benefits of retroperitoneal laparoscopy (RL) in this age group, compared
to open surgery.
MATERIAL AND METHODS
From 2012, the choice of the approach for children less than twelve months of age was decided
according to the laparoscopic experience of the surgeon; two surgeons operated by RL, 3 tro-
cars standardized technique (5, 3, 3 mm) while others operated them by dorsal lumbotomy (DL).
Analgesics and criteria for discharge were conducted according to pre-established protocol. Intra-
and postoperative parameters have been analyzed retrospectively.
RESULTS
During 5-year period, 24 RL (mean age 7 months: 1,5–11) 55 DL (5,2 months: 2–11), were in-
cluded with a mean follow-up of 27 months (5–63). Postoperative drainage was performed by
double-J stent in 13 (RL) and 5 patients (DL) or external stent in 11(RL) and 50 patients (DL).
There was no conversion in RL. Hospital stay and IV analgesics duration were significantly lower in
the RL group (2.83 days vs 2.35 days, p=0.02 respectively) while operative time was significantly
longer (163.05 min vs 85.76 min, p=0.001). A redo surgery was needed for one patient in each
group (UPJ stenosis).
34 % of DL 12 % of RL patients were operated by the fellow assisted by the senior staff.
CONCLUSIONS
Although, RL remains challenging in infants with longer operative time, it is feasible without added
morbidity compared to open surgery. The hospital stay and analgesic requirements are less. Some
drawbacks still need to improve: higher use of double J stent and the lower number of patients done
by fellows of pediatric urology.