Division of Urology, The Hospital for Sick Children, Toronto, Canada; Department of Surgery, University of Toronto, Toronto, Canada.
Division of Urology, The Hospital for Sick Children, Toronto, Canada; Institute of Urology, St. Luke's Medical Center, Quezon City, Philippines.
J Pediatr Urol. 2019 Dec;15(6):662.e1-662.e7. doi: 10.1016/j.jpurol.2019.09.003. Epub 2019 Sep 9.
For patients who require self-intermittent catheterization, a continent catheterizable stoma is a viable option. This patient population often has had previous abdominal surgery (PAS), a risk factor for complicated laparoscopic procedures. Therefore, the authors aim to determine whether PAS has an impact on the peri-operative outcomes of the laparoscopic-assisted Mitrofanoff procedure in children.
A research ethics board-approved retrospective review was performed to assess peri-operative outcomes among pediatric patients who underwent laparoscopic-assisted Mitrofanoff procedures in the authors institution from May 2000 to March 2016. Patients with no PAS were compared with those with intraperitoneal PAS. Demographic/baseline characteristics and peri-operative outcomes such as operative time, estimated blood loss, hospital stay, unanticipated additional operations, stomal stenosis, and urinary continence were compared. To ensure there is no confounding based on PAS characteristics, subgroups were created to compare the recency (PAS <1 year ago) and extent (ventriculoperitoneal (VP) shunt vs non-VP shunt PAS) to assess their peri-operative outcomes. Fisher's exact test and Mann-Whitney U test were used to determine statistical significance.
Thirty-four patients (15 no PAS and 19 PAS) were included in the analysis. No significant difference in demographics and baseline characteristics was noted between the patient groups. The median age was 6.5 years (interquartile range [IQR] 4.8-14.0) and 9.9 years (4.2-14.3), respectively (NS). Peri-operative outcomes of operative time, estimated blood loss, and hospital stay were similar between the PAS and no PAS groups. There was no statistical difference in complications requiring surgical intervention (n = 3, 20.0%; n = 9, 47.4%). The median follow-up period was 25.9 (IQR 7.7-47.2) months and 28.0 (IQR 13.0-53.0) months, respectively (NS). Patients with VP shunts as their only PAS had higher estimated blood loss compared with no PAS group (50 [IQR 25-150], 25 [IQR 25-50], respectively) but without other differences in peri-operative outcomes.
Findings support the use of a minimally invasive approach in this patient population as it is feasible, comparable, and safe but with careful consideration for risk factors that may predispose PAS patients to postsurgical complications requiring intervention. Although limited by small sample size, this study provides valuable insight into performing laparoscopic operations in children who have undergone prior surgeries and invites future studies to compare the outcomes between patients undergoing open, pure laparoscopic, and robotic-assisted laparoscopic Mitrofanoff procedures for children with PAS.
Laparoscopic-assisted Mitrofanoff creation may be safely performed in children with PAS.
对于需要自我间歇性导尿的患者，可控性膀胱造口术是一种可行的选择。这类患者群体通常有过腹部手术（PAS）史，这是腹腔镜手术复杂的一个危险因素。因此，作者旨在确定 PAS 是否会影响儿童腹腔镜辅助米托法诺夫手术的围手术期结果。
对 2000 年 5 月至 2016 年 3 月在作者所在机构接受腹腔镜辅助米托法诺夫手术的儿科患者进行了研究伦理委员会批准的回顾性研究，以评估围手术期结果。将无 PAS 的患者与有腹腔内 PAS 的患者进行比较。比较了手术时间、估计失血量、住院时间、意外附加手术、造口狭窄和尿控等围手术期结果。为了确保没有基于 PAS 特征的混杂因素，创建了亚组来比较近期（PAS<1 年前）和程度（脑室腹腔分流术（VP）分流与非 VP 分流 PAS），以评估其围手术期结果。Fisher 确切检验和 Mann-Whitney U 检验用于确定统计学意义。
34 例患者（无 PAS 15 例，PAS 19 例）纳入分析。两组患者在人口统计学和基线特征方面无显著差异。中位年龄分别为 6.5 岁（四分位距 [IQR] 4.8-14.0）和 9.9 岁（IQR 4.2-14.3）（NS）。PAS 和无 PAS 组的手术时间、估计失血量和住院时间的围手术期结果相似。需要手术干预的并发症无统计学差异（n=3，20.0%；n=9，47.4%）。中位随访时间分别为 25.9（IQR 7.7-47.2）个月和 28.0（IQR 13.0-53.0）个月（NS）。仅 VP 分流术作为唯一 PAS 的患者估计失血量高于无 PAS 组（50[IQR 25-150]，25[IQR 25-50]），但围手术期结果无其他差异。
研究结果支持在该患者群体中采用微创方法，因为它是可行的、可比的和安全的，但需要谨慎考虑可能使 PAS 患者易发生术后并发症需要干预的风险因素。尽管样本量小，但本研究为在既往接受过手术的儿童中进行腹腔镜手术提供了有价值的见解，并邀请未来的研究比较在有 PAS 的儿童中进行开放式、纯腹腔镜和机器人辅助腹腔镜米托法诺夫手术的结果。
腹腔镜辅助米托法诺夫手术可安全应用于 PAS 患儿。
