Clinical application of laparoscopic appendiceal onlay flap technique for restenosis after pyeloplasty in children
TaoTian
Cao Hualin
Zhao Xiaobo
Zhou Huixia
Li Pin
Zhao Yang
Abstract：Objective:To explore the feasibility of laparoscopic appendiceal onlayflap technique for repairing re-stenosis after pyeloplasty in children.Method:The clinical data of patients with restenosis who underwent pyeloplas-ty using the appendiceal onlay flap technique at Tangshan Maternal and Child Health Hospital and the Seventh Medi-cal Center of PLA General Hospital from October 2017 to February 2023 were retrospectively analyzed.There were a total of 9 male and 4 female patients,all presenting lesions on the right side,with an average age of 7.8(3.5-15.3)years.All patients underwent urinary ultrasound,magnetic resonance urography,and diuretic nephrolinoscintigraphy for evaluation purposes.The pedicled appendix onlay flap technique was employed for repairing long ureteral stric-tures.Postoperative complications were assessed utilizing the Clavien Dindo classification system.Result:All opera-tions were performed laparoscopically without any conversions to open surgery.The mean length of ureteral stenosis was 3.2 cm(2.5-4.3 cm),the average operative time was 182.0 minutes(150-250 min),the mean intraoperative blood loss was 34.8 ml(18-45 ml),the average duration of postoperative catheter retention was 5.6 days(3-8 d),and the mean length of postoperative hospital stay was 10.8 days(7-15 d).The incidence of Clavien-Dindo grade III complications was observed in 23.1%of cases,with three patients experiencing double J tube blockage after surgery,which improved following replacement;two patients had anastomotic leakage after surgery,which improved with continued drainage and extended indwelling time for abdominal drainage tube,without any Clavien-Dindo grade IV complications occurring.Ureteroscopy was performed on all patients when stent tubes were removed two months after the operation,revealing good anastomotic healing,unobstructed lumen,and no presence of intestinal mucus or stone formation during intraoperative exploration.Postoperative urinary ultrasound indicated reduced hydronephrosis com-pared to pre-operation levels,while diuretic renal dynamic imaging showed no upper urinary tract drainage obstruc-tion.The average follow-up period lasted for a duration of twenty-two months(12-36 months)with a surgical success rate reaching one hundred percent.Conclusion:The laparoscopic appendiceal onlay flap ureteroplasty represents a safe and feasible therapeutic option for managing complex right ureteral strictures in pediatric patients,thus making it an advantageous choice for addressing extensive right ureteral strictures.
Keywords：childrenlaparoscopespyeloplastyappendiceal onlay flapureteral stricture
Publication Date：2024-08-05
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：5( 115-119 )