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    • The operative results of the patients in the three

    2018-10-29

    The operative results of the patients in the three groups are summarized in Table 2. There were no statistically significant differences in the operative time between Groups II and III. Nevertheless, the operative time in Group II or III was longer than that in Group I (p < 0.001), which was correlated with the learning curve for laparoscopic surgery. Preoperatively, percutaneous nephrostomy drainage was performed on the decision of the pediatric nephrologist. The duration of perianastomotic drainage was longer in Group III than in the other two groups. A lot of serosanguious ascites was obtained from the drainage tubes in patients who underwent transperitoneal laparoscopic surgery, therefore, the drainage tubes were kept for a longer period of time. One patient in Group III had postoperative urine leakage, which was resolved by urinary diversion using percutaneous nephrostomy drainage. There was no shortening of hospital stay, but good cosmetic results and early return to normal activity were obtained. Successful resolution of UPJO was noted in almost all patients except one in the open surgery group, who was treated by “re-do” pyeloureterostomy. Resolution of UPJO was confirmed by improvement in ultrasound and diuretic renography.
    Discussion Since the first open pyeloplasty was performed by Trendelemburg in 1886, the open procedure has been the gold standard treatment with reported success rates of >95% at follow-up, but with the disadvantages of postoperative pain, prolonged recovery, and long incision. Endopyelotomy, first described by Wickham and Kellet in 1983, is an alternative that provides a less-invasive treatment but lower success rate (40–70%) as compared to open pyeloplasty. Besides, it is indicated only in patients with a small renal 4-ap and a short UPJ stenosis or a significant stone with obstruction. Since the late 1990s, there have been several reports of laparoscopic pyeloplasty in pediatrics using the transperitoneal or retroperitoneal approach. In all pediatric patients, laparoscopic pyeloplasty may be performed safely, but is more difficult and time consuming in infants (<1 year old). Tan has suggested that laparoscopic pyeloplasty should not be considered in infants younger than 6 months. By contrast, some have demonstrated that laparoscopic pyeloplasty is safe and effective in young children aged >2 months. In our patients, a hybrid procedure was nonrandomly performed in infants and young children due to the limitation of the surgeon\'s experience and should be considered as a safe, effective, and less-invasive alternative. Postoperative complications had an incidence rate ranging from 11.7% to 24%, and were usually related to urine leak and persistent drainage, and were often treated conservatively without sequelae. Other complications, such as trocar hematoma, bleeding, misplaced stent, urinary tract infection, postoperative ileus, perirenal urinoma, anastomotic leakage, progression of the UPJ anastomosis, and stricture formation have also been described. The overall complication rate in our patients was only 4.8% (2 in 43 renal units) and 5.3% (1/19) in the pure laparoscopic group.
    Introduction Single-incision laparoscopic surgery (SILS) has emerged in an attempt to reduce postoperative pain and further enhance the cosmetic benefits of conventional laparoscopic surgery. Recent studies have reported satisfactory results of SILS for cholecystectomy, sleeve gastrectomy, and colectomy. Laparoscopic gastric bypass is one of the most complicated laparoscopic procedures, and SILS is not yet in popular use because the intracorporeal sutures and anastomosis cannot be achieved exactly. The laparoscopic Roux-en-Y gastric bypass, which is more complex than a mini-gastric bypass, is an effective bariatric surgical procedure. From five to seven ports, however, are usually required for this procedure, including three 12 mm ports set separately for staplers, and scope usage as in conventional gastric bypass surgery. A mastery of intracorporeal sutures is also needed to perform the operation. In regard to SILS surgery, we developed a modified technique for performing a Roux-en-Y gastric bypass, which will be presented here along with the associated learning curve.