Laparoscopic transposition of lower pole crossing vessels (vascular hitch) in children with pelviureteric junction obstruction

Ciro Esposito, Cosimo Bleve, Maria Escolino, Paolo Caione, Simona Gerocarni Nappo, Alessandra Farina, Maria Grazia Caprio, Mariapina Cerulo, Angela La Manna, Salvatore Fabio Chiarenza

Research output: Contribution to journalArticle

Abstract

Background: Congenital hydronephrosis due to intrinsic or extrinsic uretero-pelvic-junction (UPJ) obstruction (UPJO) is a common problem in childhood UPJO may be caused by intrinsic disorganization or by extrinsic compression from crossing vessels (CV); extrinsic causes usually present symptomatically in older children. This report the large Italian experience in the treatment of children with extrinsic-UPJO by CV. Methods: We analyzed the data of 51 children (17 girls and 34 boys, median age 10, 7 years) affected by extrinsic-UPJO were treated in three Italian institutions with laparoscopic transposition of CV (Hellström Vascular Hitch modified by Chapman).The intraoperative diuretic-Test was performed in all patients before and after the vessels transpositions confirming the extrinsic-UPJO. We included in the study only patients with suspicion of vascular extrinsic obstruction of the UPJ. Symptoms at presentation were recurrent abdominal/flank pain and haematuria. All patients presented intermittent ultrasound (US) detection of hydronephrosis (range, 18-100 mm). Preoperative diagnostic studies included: US/doppler scan, MAG3-renogram, functional-magnetic-resonance-urography (fMRU). Results: Median operative time was 108 minutes; median hospital stay: 3, 4 days. Unique complications: A small abdominal wall hematoma and higher junction-Translocation without obstruction. During follow-up (range, 12-96 months) all patients reported resolution of their symptoms, a decrease in the hydronephrosis grade and improved drainage on diuretic renogram.Conclusions: We believe that Vascular Hitch is less technically demanding than laparoscopic pyeloplasty, resulting in a lower complication rate and a significantly reduced hospitalization. The results of our study allow us to conclude that laparoscopic VH may be a safe, feasible, and attractive alternative to treat obstructed hydronephrosis due to CV presenting a useful alternative to AHDP in the management of symptomatic children where CV are deemed the sole aetiology. We recommend careful patient selection based on preoperative clinical and radiologic findings that are diagnostic of extrinsic-UPJO, combined with intraoperative-DT to confirm the appropriate selection of corrective procedure.

Original languageEnglish
Pages (from-to)256-261
Number of pages6
JournalTranslational Pediatrics
Volume5
Issue number4
DOIs
Publication statusPublished - 2016

Fingerprint

Hydronephrosis
Blood Vessels
Diuretics
Flank Pain
Doppler Ultrasonography
Urography
Abdominal Wall
Hematuria
Operative Time
Hematoma
Abdominal Pain
Patient Selection
Drainage
Length of Stay
Hospitalization
Magnetic Resonance Spectroscopy
Bilateral Multicystic renal dysplasia
Therapeutics

Keywords

  • Extrinsic uretero pelvic junction obstruction
  • Laparoscopy
  • Vascular hitch

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Laparoscopic transposition of lower pole crossing vessels (vascular hitch) in children with pelviureteric junction obstruction. / Esposito, Ciro; Bleve, Cosimo; Escolino, Maria; Caione, Paolo; Nappo, Simona Gerocarni; Farina, Alessandra; Caprio, Maria Grazia; Cerulo, Mariapina; Manna, Angela La; Chiarenza, Salvatore Fabio.

In: Translational Pediatrics, Vol. 5, No. 4, 2016, p. 256-261.

Research output: Contribution to journalArticle

Esposito, Ciro ; Bleve, Cosimo ; Escolino, Maria ; Caione, Paolo ; Nappo, Simona Gerocarni ; Farina, Alessandra ; Caprio, Maria Grazia ; Cerulo, Mariapina ; Manna, Angela La ; Chiarenza, Salvatore Fabio. / Laparoscopic transposition of lower pole crossing vessels (vascular hitch) in children with pelviureteric junction obstruction. In: Translational Pediatrics. 2016 ; Vol. 5, No. 4. pp. 256-261.
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AU - Esposito, Ciro

AU - Bleve, Cosimo

AU - Escolino, Maria

AU - Caione, Paolo

AU - Nappo, Simona Gerocarni

AU - Farina, Alessandra

AU - Caprio, Maria Grazia

AU - Cerulo, Mariapina

AU - Manna, Angela La

AU - Chiarenza, Salvatore Fabio

PY - 2016

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N2 - Background: Congenital hydronephrosis due to intrinsic or extrinsic uretero-pelvic-junction (UPJ) obstruction (UPJO) is a common problem in childhood UPJO may be caused by intrinsic disorganization or by extrinsic compression from crossing vessels (CV); extrinsic causes usually present symptomatically in older children. This report the large Italian experience in the treatment of children with extrinsic-UPJO by CV. Methods: We analyzed the data of 51 children (17 girls and 34 boys, median age 10, 7 years) affected by extrinsic-UPJO were treated in three Italian institutions with laparoscopic transposition of CV (Hellström Vascular Hitch modified by Chapman).The intraoperative diuretic-Test was performed in all patients before and after the vessels transpositions confirming the extrinsic-UPJO. We included in the study only patients with suspicion of vascular extrinsic obstruction of the UPJ. Symptoms at presentation were recurrent abdominal/flank pain and haematuria. All patients presented intermittent ultrasound (US) detection of hydronephrosis (range, 18-100 mm). Preoperative diagnostic studies included: US/doppler scan, MAG3-renogram, functional-magnetic-resonance-urography (fMRU). Results: Median operative time was 108 minutes; median hospital stay: 3, 4 days. Unique complications: A small abdominal wall hematoma and higher junction-Translocation without obstruction. During follow-up (range, 12-96 months) all patients reported resolution of their symptoms, a decrease in the hydronephrosis grade and improved drainage on diuretic renogram.Conclusions: We believe that Vascular Hitch is less technically demanding than laparoscopic pyeloplasty, resulting in a lower complication rate and a significantly reduced hospitalization. The results of our study allow us to conclude that laparoscopic VH may be a safe, feasible, and attractive alternative to treat obstructed hydronephrosis due to CV presenting a useful alternative to AHDP in the management of symptomatic children where CV are deemed the sole aetiology. We recommend careful patient selection based on preoperative clinical and radiologic findings that are diagnostic of extrinsic-UPJO, combined with intraoperative-DT to confirm the appropriate selection of corrective procedure.

AB - Background: Congenital hydronephrosis due to intrinsic or extrinsic uretero-pelvic-junction (UPJ) obstruction (UPJO) is a common problem in childhood UPJO may be caused by intrinsic disorganization or by extrinsic compression from crossing vessels (CV); extrinsic causes usually present symptomatically in older children. This report the large Italian experience in the treatment of children with extrinsic-UPJO by CV. Methods: We analyzed the data of 51 children (17 girls and 34 boys, median age 10, 7 years) affected by extrinsic-UPJO were treated in three Italian institutions with laparoscopic transposition of CV (Hellström Vascular Hitch modified by Chapman).The intraoperative diuretic-Test was performed in all patients before and after the vessels transpositions confirming the extrinsic-UPJO. We included in the study only patients with suspicion of vascular extrinsic obstruction of the UPJ. Symptoms at presentation were recurrent abdominal/flank pain and haematuria. All patients presented intermittent ultrasound (US) detection of hydronephrosis (range, 18-100 mm). Preoperative diagnostic studies included: US/doppler scan, MAG3-renogram, functional-magnetic-resonance-urography (fMRU). Results: Median operative time was 108 minutes; median hospital stay: 3, 4 days. Unique complications: A small abdominal wall hematoma and higher junction-Translocation without obstruction. During follow-up (range, 12-96 months) all patients reported resolution of their symptoms, a decrease in the hydronephrosis grade and improved drainage on diuretic renogram.Conclusions: We believe that Vascular Hitch is less technically demanding than laparoscopic pyeloplasty, resulting in a lower complication rate and a significantly reduced hospitalization. The results of our study allow us to conclude that laparoscopic VH may be a safe, feasible, and attractive alternative to treat obstructed hydronephrosis due to CV presenting a useful alternative to AHDP in the management of symptomatic children where CV are deemed the sole aetiology. We recommend careful patient selection based on preoperative clinical and radiologic findings that are diagnostic of extrinsic-UPJO, combined with intraoperative-DT to confirm the appropriate selection of corrective procedure.

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