Laparoscopic pyeloplasty: status and review of literature.

The ideal treatment for ureteropelvic junction (UPJ) obstruction should have the highest success rate, enable treatment of all types of obstruction, allow removal coexisting renal stones, and be minimally invasive. Open pyeloplasty offers all these features except the last (minimal invasiveness), whereas endourology techniques guarantee only the last one. Different techniques of pyeloplasty can be applied laparoscopically, although the best results are seen with dismembered pyeloplasty (Anderson-Hynes technique). Various methods of tissue approximation have been devised to avoid the difficult-to-master, time-consuming conventional suturing technique. Laparoscopic (antegrade) stenting is preferred by some surgeons, but we consider retrograde stenting is superior, as this rules out the presence of associated distal-ureteral obstruction. The transperitoneal approach has the advantages of a larger working space and readily identifiable anatomic landmarks. However, access to the renal pelvis requires considerable mobilization and retraction of the overlying loops of bowel. The retroperitoneal approach has the perceived disadvantage of a somewhat limited working space and absence of readily identifiable intra-abdominal anatomic structures such as the liver and spleen. However, the retroperitoneal approach has the advantage of greater familiarity, better detection of crossing vessels, direct and rapid access to the UPJ, and less risk of ileus. The robot-assisted technique has made suturing easier and may allow expansion of advanced laparoscopic procedures to surgeons without expertise in advanced laparoscopic surgery. The optimal length of follow-up after pyeloplasty is still unclear. Although most failures occur within the first 2 years, failures continue to appear after 5 and 10 years.

Laparoscopic pyeloplasty: evolution of a new gold standard.

OBJECTIVES: To report our series of laparoscopic dismembered pyeloplasty for the treatment of primary and secondary ureteropelvic junction obstruction and to review the current status of this procedure. METHODS: A total of 170 consecutive cases of laparoscopic pyeloplasty (156 for primary and 14 for secondary ureteropelvic junction obstruction) were performed or supervised by a single surgeon (C.G.E). A four-port extraperitoneal approach was used in all but 3 cases, which were performed transperitoneally. RESULTS: The median operative time was 140 minutes. The complication rate was 7.1%, and the conversion rate was 0.6%, with no conversion in the last 161 cases. The median postoperative hospital stay was 3 nights. Crossing vessels were encountered in 42% of cases, and in 11 patients, coexisting renal calculi were successfully removed. At a median follow-up of 12 months, the success rate was 96.2%. CONCLUSIONS: Laparoscopic dismembered pyeloplasty produces functional results comparable to that of open surgery with the advantages of a minimally invasive procedure. Our results are consistent with previous series and support the view that laparoscopic pyeloplasty is moving rapidly toward replacing open surgery as the gold standard in the treatment of ureteropelvic junction obstruction.

Tropical splenomegaly syndrome: who gets oesophageal varices?

Of sixty eight patients with tropical splenomegaly syndrome (TSS), 12 had asymptomatic oesophageal varices (OV). All 12 had massive splenomegaly (Hackett's stage 4 or 5). Eight of the 12 were multiparous females, mainly of Rwandese origin. Endoscopic appearance of the varices suggested that TSS varices were not likely to bleed. None of the patients with the varices had abdominal collaterals belonging to the portal system.

Endoscopy versus radiology in African AIDS patients with oesophageal disorders

Upper gastrointestinal endoscopy and double contrast barium radiology were compared prospectively in 45 Ugandan patients with AIDS and upper gastrointestinal oesophageal symptoms. Both investigating techniques were normal as was the histopathology in 5 patients. In 40 cases a definite pathological diagnosis (candidiasis; non-specific inflammation; malignancy) was made. Endoscopic examination provided a correct disgnosis in 38 cases; while only 15 cases were diagnosised from barium studies. Radiology was normal in 2 cases later proved to have definite pathology on endoscopy and histopathologic examination (oesophageal candidiasis). Endoscopy in this series was found to have 95sensitivity in diagnosing oesophageal disorders in AIDS patients; compared to a sensitivty of 37.5for radiology. The difference between the two procedures regarding sensitivity was statistically significant (p0.005). A combination of oral thrush and dysphagia was strongly associated with oesophageal candidiasis (positive predictive value 95; p0.0025). Endoscopy would be the ideal diagnostic procedure for oesophageal candidiasis. The above finding; however; provides a basis for empirical antifungal therapy especially in places where diagnostic facilities are limited

Endoscopic surgery of the vidian nerve. Preliminary report.

The anatomy, surgical technique, and difficulties of endoscopic vidian neurectomy are described. The procedure was carried out on 12 patients: 8 had resistant secretomotor rhinopathy and 4 had recurrent nasal polyposis. This technique is a minor surgical procedure with symptomatic relief and minimal postoperative morbidity.

Microfissures of the temporal bone: do they have any clinical significance?

Microfissures extending from the inner ear to the middle ear are a common temporal bone finding. Recently they have been implicated as a possible cause of sudden sensorineural hearing loss. We examined 34 temporal bones and related the presence or absence of microfissures to sudden sensorineural hearing loss. No relationship was found.