Laparoscopic nephrectomy in children for benign conditions: indications and outcome.

AIM: To analyze the indications and outcome of laparoscopic nephrectomy for benign non-functioning kidneys in children. MATERIALS AND METHODS: The data of all patients operated over a 10 year period was retrospectively analyzed. RESULTS: There were 56 children, aged 4 months to 12 years with a male: female ratio of 2.3:1. The most common presentation in boys and girls was urinary tract infection (UTI) (61.5% and 47.05% respectively). Incontinence due to ectopic ureter was a close second in girls (41.17%). The most common underlying conditions were vesico-ureteric reflux (42.85%) and multicystic dysplastic kidney (23.2%). There were 6 nephrectomies, 4 heminephroureterectomies and the remaining nephroureterectomies. All children tolerated the surgery well. One patient underwent a concomitant cholecystectomy. The post-operative problems encountered were UTI (1), urine retention (1), pyonephrosis in the opposite kidney and development of contra-lateral reflux (1). All others had resolution of pre-operative symptoms with good cosmesis. CONCLUSIONS: As per available literature, this appears to be the largest Indian series of pediatric laparoscopic nephrectomies for benign non-functioning kidneys. Laparoscopic approach gives excellent results provided pre-operative investigations rule out other causes for the symptoms with which the patient presents. Often it is not the kidney but the dilated dysplastic ureter which is the seat of stasis and infection or pain and therefore should be completely removed.

A prospective study comparing histology and enteric enzyme function of patients with extrahepatic portal vein obstruction before and after shunt surgery.

BACKGROUND: This was a prospective observational study carried out to objectively assess the effect of shunt surgery on intestinal morphology and function in patients with extrahepatic portal vein obstruction (EHPVO) and correlate it with growth improvement. PATIENTS AND METHODS: Twenty patients who were operated upon for EHPVO were divided into two groups for the purpose of analysis depending on the outcome of surgery: group A--patients who underwent successful shunt surgery (n=14) and group B--patients who underwent splenectomy with devascularization (n=1) and those with thrombosed shunts (n=5). The patient groups were created on the basis of the type and outcome of the surgery and not prospective stratification. Growth parameters, endoscopy findings, duodenal histology, brush border enzyme activity, urinary D-xylose levels, fecal steatocrit, fecal α-1 antitrypsin, serum growth hormone and insulin-like growth factor-1 levels, and quality-of-life scores were assessed before surgery and at a mean of 24.9 weeks after surgery. RESULTS: There was no significant difference between the preoperative and postoperative duodenal histology. Preoperative brush border lactase activity was significantly lower than normal and did not change significantly after surgery. EHPVO did not affect intestinal absorption or permeability. Shunt surgery resulted in significantly improved z scores for height after surgery as well as quality of life. There was no significant growth hormone resistance. CONCLUSION: Our patients did not have any significant malabsorption or abnormality in small intestinal structure and function when compared with established normal levels. There was no significant change in the above parameters after shunt surgery, although an improvement in growth was observed. Thus, factors other than enteropathy or other lesser known enteral factors seem to be responsible for the growth retardation observed in EHPVO and its subsequent improvement after shunt surgery.

Retrocaval ureter with stone in the retrocaval segment of the ureter.

Retrocaval ureter is abnormal looping of the proximal ureter behind the inferior vena cava. The aberrant anatomy results in the compression of the ureter causing hydronephrosis. This is a very infrequent cause of hydronephrosis in children. Association of retrocaval ureter with a stone in the looping segment of the ureter is extremely rare. We report one such pediatric case which was diagnosed preoperatively with a review of pediatric-only cases reported in last 5 years.