Manisa Celal Bayar University, Faculty of Medicine, Dept. of Pediatric Surgery, Manisa, Turkey.
Manisa Celal Bayar University, Faculty of Medicine, Dept. of Pediatric Surgery, Manisa, Turkey.
J Pediatr Urol. 2019 Dec;15(6):660.e1-660.e5. doi: 10.1016/j.jpurol.2019.07.023. Epub 2019 Aug 7.
Laparoscopic pyeloplasty for ureteropelvic junction obstruction in children has gained increasing importance over the last decade. Intracorporeal knot tying still remains a technical challenge for the surgeon. Self-anchoring suture incorporates a new concept for tissue approximation and reduces intracorporeal knot tying problems. There are very few reports on self-anchoring knotless suture and its application for laparoscopic pyeloplasty in children. We present our results of a series of consecutive children undergoing laparoscopic pyeloplasty with knotless barbed sutures.
We prospectively evaluate 15 consecutive patients who underwent laparoscopic pyeloplasty with knotless barbed sutures (V-Loc, Covidien) for ureteropelvic anastomosis. The decision of the operation was given by pediatric nephrology-urology-radiologic imaging diagnostic team, and all patients were operated by a single surgeon. Pyeloplasty was performed without pelvic reduction, and the anastomosis was made by barbed sutures using running fashion.
The mean age of the patients were 5.39 (3 months-17 years). Two cases had undergone a right-sided pyeloplasty, and thirteen had undergone a left-sided pyeloplasty. The duration of the operative procedure was 60-110 min. Neither intraoperative nor postoperative complication was encountered in any of the cases. Patients were followed by ultrasonographic evaluation. The anteroposterior diameter (AP) diameter of renal pelvis and hydronephrosis grade Society for Fetal Urology (SFU) are significantly different when compared with pre-operative and postoperative period (p = 0.001 and p = 0.001, respectively). Owing to the renal parenchymal thickness change by age pre-operative and postoperative thickness comparison is adjusted by age, because age is considered as a covariate (confounder variable). We observed statistically significant (p = 0.003) difference in parenchymal thickness in all cases. Follow-up periods of the 15 consecutive pediatric pyeloplasty cases were 6-54 months.
In the present study, successful outcome of the laparoscopic pyeloplasty using barbed suture was shown for the first time in children in literature. We believe that successful outcome of laparoscopic pyeloplasty could be achieved by eliminating knots and less manipulation on the wound edge also minimizes tissue injury during the procedure.
腹腔镜肾盂成形术治疗儿童肾盂输尿管连接部梗阻在过去十年中变得越来越重要。腔内打结仍然是外科医生面临的技术挑战。自固定缝线采用了一种新的组织接近概念，减少了腔内打结问题。关于自固定无结缝线及其在儿童腹腔镜肾盂成形术中的应用的报道很少。我们介绍了一系列连续接受腹腔镜肾盂成形术无结缝线（V-Loc，Covidien）治疗的儿童患者的结果。手术决策由儿科肾脏病学-泌尿科-放射影像学诊断小组作出，所有患者均由一名外科医生手术。肾盂成形术未行肾盂复位，吻合采用带刺缝线行连续式缝合。
我们前瞻性评估了 15 例连续接受腹腔镜肾盂成形术无结缝线（V-Loc，Covidien）治疗的儿童患者，用于肾盂输尿管吻合术。手术决策由儿科肾脏病学-泌尿科-放射影像学诊断小组作出，所有患者均由一名外科医生手术。肾盂成形术未行肾盂复位，吻合采用带刺缝线行连续式缝合。
患者的平均年龄为 5.39 岁（3 个月至 17 岁）。2 例为右侧肾盂成形术，13 例为左侧肾盂成形术。手术时间为 60-110 分钟。所有病例均未发生术中或术后并发症。患者均接受超声评估。肾盂前后径（AP）和肾积水分级社会胎儿泌尿学会（SFU）与术前和术后相比均有显著差异（p=0.001 和 p=0.001）。由于肾实质厚度随年龄变化，因此术前和术后厚度比较需要按年龄调整，因为年龄被视为协变量（混杂变量）。我们观察到所有病例的肾实质厚度均有统计学显著差异（p=0.003）。15 例连续儿童肾盂成形术的随访时间为 6-54 个月。
在本研究中，首次在文献中报道了儿童应用带刺缝线腹腔镜肾盂成形术的成功结果。我们相信，通过消除结和减少对伤口边缘的操作，可以实现腹腔镜肾盂成形术的成功结果，并且在手术过程中最大限度地减少组织损伤。
