ABSTRACT
Nephrectomy, nephroureterectomy and heminephroureterectomy for congenital anomalies are common procedures in the pediatric urological practice. The use of laparoscopy in such procedures is claimed to be an excellent alternative to the classical open technique, and is rapidly becoming the gold standard, laparoscopy could be performed through either a transperitoneal or a retroperitoneal approach. The aim of this study was to compare the laparoscopic retroperitoneal nephrectomy technique in children with its open counterpart. Between August 2003 and August 2005; 13 cases [mean age 4.5 years [range 2-14 years]] were operated upon in our department using the laparoscopic retroperitoneal technique: four heminephroureterectomies [double system with or without ureterocele], four nephroureterectomies [two posterior urethral valves and two vesico-ureteric reflux cases] and five simple nephrectomies [one multicystic dysplasti kidney, one neglected uretero-pelvic junction obstruction, one pyonephrosis and two refluxing non functioning kidneys]. The procedure was performed using a 3-port technique [two 5mm and one 10 mm ports]. This peri and postoperative data of this group was compared retrospectively to a similar group of 10 patients who underwent open nephrectomies during the same period. The mean follow up was 9 months [range 4-18 months]. In the laparoscopic group, the mean operative time was 145 minutes [range 90-180 minutes] and no blood transfusion was needed. There was no need for intravenous analgesia except in one patient. Bowel movement was recovered between 6 and 8 hours [mean 7 hours] postoperatively. The drain was removed after 12 to 16 hours [mean 12 hours] and children were discharged after 24 to 36 hours [mean 24 hours]. One heminephroureterectomy was converted to an open technique [due to technical problems]. Two cases were completed by the transperitoneal route [one nephrectomy with previous percutaneous nephrostomy and one heminephroureterectomy] due to difficulty to create/loss of the laparoscopic retroperitoneal space. In the open surgery group, the mean operative time was 105 minutes [range 60-130 minutes] and no blood transfusion was needed. Intravenous analgesia was necessary in 8 children. Bowel movement was recovered 12 to 18 hours postoperatively [mean 12 hours]. The drain was removed 48 to 120 hours postoperative [mean 72 hours] and children discharged after 3 to 5 days [mean 3 days]. Laparoscopic retroperitoneal nepherectomy, nephroureterectomy and heminephroureterectomy in children are feasible, safe and provide an excellent alternative to open surgery. The retroperitoneal approach may even be superior to the transperitoneal approach; however, large numbered studies are needed to confirm this