Simplified stenting methods during laparoscopic pyeloplasty in children

Abstract

We are dedicated to evaluate a simplified methods for ureteric stent insertion during laparoscopic pyeloplasty in children. After detect the cause of obstruction, UPJ resection was made. At that stage, we performed antegrade extracorporeal installation of stent by removing the proximal ureter through the lower skin defect after extraction of the trocar. That allowed for successful stenting under precise tactile and visual control. Then the ureter was reintroduced back into abdominal cavity. Dismembered LP by Hynnes-Andersen technique was made using 6/0 absorbable monofilament suture. The second method of ureteric stenting: after the anastomosis of posterior pelvis wall is complete, puncturing with Veress needle between the optics and the upper trocar. The stylet was removed, after that we can introduce a stent through the needle hole with ensure accurate tactile sensations, maximum control over the stent direction. Since January 2017, we have used this method in 32 children with congenital hydronephrosis were operated by LP. The proposed methods of ureteric stenting allowed reducing that stage to 3-10 minutes, with successful outcome in all cases. The children were discharged 5-7 days after surgery. No conversion to open surgery had to be performed. Our experience shows that LP in children with congenital HN reduces the surgical burden on the patient, improves post-surgery quality of life. The proposed methods of antegrade intraoperative stenting significantly reduce the duration of surgery while improving the success rate of this key manipulation.