Single incision miniature pyeloplasty and ipsilateral inguinal herniorrhaphy in infants.

Abstract

PURPOSE: We describe a single incision miniature open pyeloplasty and retroperitoneal herniorrhaphy technique in infants. MATERIALS AND METHODS: A total of 22 patients with ureteropelvic junction obstruction and concomitant inguinal hernia were referred to our center between November 2003 and November 2008. A total of 13 patients (mean age 5 months) with extensively dilated pelves (extending down to pelvic cavity) and ipsilateral inguinal hernia underwent single incision miniature open pyeloplasty and retroperitoneal herniorrhaphy. All patients had decreased differential renal function (less than 40%), urinary tract infection, palpable kidney and obstructive pattern on renal diethylenetriamine pentaacetic acid scan. The incision was made along the most dependent part of the lower quadrant. After dissection of the ureteropelvic junction component, we pulled out the affected section and performed classic dismembered pyeloplasty without renal pelvis reduction. Next, we performed retroperitoneal herniorrhaphy from the same incision. Surgical incision size, operative time, hospital stay, postoperative analgesic use and complication rate were recorded for further evaluation. RESULTS: The operation was uneventful in all patients. Mean operative time was 64 minutes (range 47 to 93) and patients were discharged home after a mean +/- SD of 19 +/- 3 hours (15 to 24). Incision size was 12 to 18 mm and the incision was closed by inserting a mini Hemovac closed drain. No narcotic supplementation was required postoperatively and there were no complications during followup. CONCLUSIONS: Single incision miniature pyeloplasty with ipsilateral inguinal herniorrhaphy in an extensively dilated pelvis and ipsilateral inguinal hernia is technically feasible and safe in selected cases. The exact incision site must be reconfirmed intraoperatively by physical examination or renal ultrasound. The technique adds the advantages of minimally invasive procedures (small incision, negligible postoperative pain) to the short operative time and high success rate of the open approach.