Short stay pyeloplasty with transverse dorsal lumbotomy incision: our 10-year experience

Abstract

Objectives: To review our long-term results with a modified dorsal lumbotomy (DL) approach and evaluate its role as a minimally-invasive alternative for the surgical management of ureteropelvic junction obstruction (UPJO).

Methods: Fifty-nine consecutive children (42 males, 17 females, median age: 5.7 years) underwent pyeloplasty with transverse DL (TDL) between 1999 and 2008. Kidney stones, solitary kidney, and bilateral UPJ obstruction was present in 6, 3, and 5 children, respectively. Forty-nine and 10 children received stented dismembered pyeloplasty and Y-V plasty, respectively. Information on the duration of surgery, length of hospital stay, length of time to return to unrestricted activity, and per/postoperative complications was recorded. Children were followed up postoperatively with urinalysis and ultrasonography (US) at first month, diuretic renogram or intravenous urography (IVU) or both at sixth month, and yearly thereafter with US and renal scintigraphy for the emergence of recurrent clinical symptoms, deterioration of differential renal function, or increase in hydronephrosis.

Results: Median operative time was 78 minutes and median incision length ranged between 3 and 5 cm for all age groups. All children tolerated liquid diet within the evening of surgery and returned to unrestricted activity within 48 hours. Eight-eight percent of all patients were discharged within 2 days, and 88% of children operated after 2004 were discharged in less than 30 hours. Recurrent UPJO was not evident in any case with a median follow-up of 56 months.

Conclusions: TDL provides excellent exposure for UPJO repair with a cosmetically appealing scar while maintaining a minimal convalescence advantage. It is particularly beneficial in bilateral pyeloplasty as synchronous bilateral repair can be performed without repositioning the patient.