Management Strategies and Preventive Measures for Early Complications After Laparoscopic Pyeloplasty in Children
YUAN Enmeng
YANG Yanfang
LI Xing
BI Jianpeng
LI Liangbin
FAN Hongjie
YANG Yang
Abstract：Objective To explore the management strategies and preventive measures for early complications after laparoscopic pyeloplasty for ureteropelvic junction obstruction(UPJO)in children.Methods A retrospective analysis was conducted on 180 children who underwent laparoscopic pyeloplasty in the Department of Urology at Henan Children's Hospital from January 2020 to June 2023.During the surgery,172 cases underwent double J tube placement,and 8 cases underwent nephrostomy with ureteral stent placement.The management strategies and preventive measures for common postoperative complications in the early stage were summarized and analyzed.Results Forty-five cases experienced complications,with an incidence rate of 25.0％(45/180).According to the Clavien-Dindo grading system,there were 19 cases of grade Ⅰ(10.6％),18 cases of grade Ⅱ(10.0％),4 cases of grade Ⅲ a(2.2％),and 4 cases of grade Ⅲb(2.2％).Among them,there were 7 cases of complications related to laparoscopy and pneumoperitoneum,including 6 cases of subcutaneous emphysema and 1 case of puncture hernia.There were 3 cases of complications related to abdominal drainage tubes,including 1 case of difficulty in removing the drainage tube and having it removed in the operating room,and 2 cases of omental bulging during the removal of the drainage tube;three cases of urinary leakage at the anastomotic site were treated with reduced activity and bed rest,and the drainage volume gradually decreased.Thirty cases of complications related to the double J tube,including 3 cases of double J tube blockage,15 cases of febrile urinary tract infection,2 cases of distal displacement of the double J tube to the urethra,5 cases of lower back pain,and 5 cases of hematuria.Two cases of early re obstruction after removal of the double J tube were reported,presenting with lower back pain and extreme dilation of the renal pelvis.Ureteroscopy was performed and two double J tubes were retained.One case had a slight increase in renal pelvis separation after removal of the double J tube,but had no clinical symptoms.After follow-up for one year,renal hydronephrosis gradually decreased,and there were no symptoms such as lower back pain or urinary tract infection during this period.One case had a significant reduction in hydronephrosis after removal of the double J tube and re-examination of color Doppler ultrasound two months later.By comparing the clinical data of the complication group and the non complication group,univariate logistic regression analysis suggests that surgical age ≤ 1 year and surgical time are risk factors for early postoperative complications.Conclusion The overall success rate of laparoscopic pyeloplasty in children is high,and its early complications are mostly Clavine grade Ⅰ and grade Ⅱ.Surgical age≤1 year and surgical time are risk factors for early postoperative complications.By improving surgical details and prophylactic use of antibiotics after surgery,the occurrence of complications can be effectively prevented.
Keywords：laparoscopic pyeloplastychildrenearly complicationsprevention
Publication Date：2025-05-28
Online Publishing Date：2026-09-12(First online date of this platform, not the publication date of the document)
Pages：5( 1753-1757 )