Selçuk ŞAHİN, Kamil Gökhan ŞEKER, Mustafa Gürkan YENİCE, Nevzat Can ŞENER, Volkan TUĞCU

Laparoskopik piyeloplasti: Hangi yaklaşım? Tek merkez deneyimi

Amaç: Bu çalışmanın amacı, kliniğimizde primer üreteropelvik bileşke darlığı nedeniyle laparoskopik transperitoneal piyeloplasti LTPP ve laparoskopik retroperitoneal piyeloplasti LRPP laparoscopic retroperitoneal pyeloplasty LRPP operasyonu yapılan 112 hastanın verilerini geriye operations at our clinic due to primary ureteropeldönük incelemek ve deneyimimizi sunmaktır. Materyal ve Metod: Ocak 2007 ile Ocak 2015 tarihleri arasında primer üreteropelvik bileşke who had standard laparoscopic pyeloplasty between darlığı tanısı ile standart laparoskopik piyeloplasti January 2007 and January 2015 with a primary UPJ operasyonu yapılan hastaların verileri incelendi. obstruction were examined. Comparative data from Transperitoneal ve retroperitoneal laparoskopik transperitoneal and retroperitoneal laparoscopic yaklaşım verileri karşılaştırılmalı istatistiksel olarak analiz edildi.Bulgular: Hastaların 74 hasta transperitoneal, 38 hasta retroperitoneal demografik ve transperitoneal, 38 patients with retroperitoneal klinik özelliklerine bakıldığında iki grup arasınsurgery , there were no significant differences beda herhangi bir anlamlı farklılık yoktu. Ortalama operasyon süresi transperitoneal yaklaşımda 149.52 minutes in the transperitoneal approach and 149.52 dk, retroperitoneal yaklaşımda ise 187,76 187.76 minutes in the retroperitoneal approach. Indk idi. İntrakorporeal sütürasyon transperitoneal yaklaşımda ortalama 66.4 dk, retroperitoneal in the transperitoneal approach and 84.21 minutes yaklaşımda ise 84.21 dk idi. Postoperatif 1. ve 2. in the retroperitoneal approach. The visual anagünde değerlendirilen visuel analog skoru VAS , analjezik gereksinimi, hastanede kalış süresi LTPP yapılan grupta LRPP yapılan gruba oranla yüksek bulundu. Hiçbir hastada Clavien 4-5 derece komplikasyon görülmedi. Her iki grupta da 1 hastada One patient in each group had to undergo converoperasyon açığa geçilerek tamamlandı. sion to open surgery.Sonuç: Transperitoneal yaklaşım cerrah açısından daha geniş çalışma alanı, daha kolay ve kısa sürede intrakorporeal sütürasyon, aberran damar varlığında daha kolay kontrol sağlaması, kısa operasyon süresi ile retroperitoneal yaklaşıma göre daha avantajlı olarak görüldü. Retroperitoneal yaklaşım ise gastrointestinal sistem bulguları, postoperatif ağrı ve kısa hastanede kalış süresi bakımından transperitoneal yaklaşıma üstün bulundu. Uzun dönem takiplerde her iki grupta da yüksek başarı oranları sağlandı

Anahtar Kelimeler:

Piyeloplasti, Transperitoneal, Retroperitoneal, Primer Üreteropelvik bileşke darlığı

Laparoscopic pyeloplasty: Which approach? Single center experience

Objective: The aim of this study is to retrospectively examine the data of 112 patients who had laparoscopic transperitoneal pyeloplasty LTPP or laparoscopic retroperitoneal pyeloplasty LRPP operations at our clinic due to primary ureteropelvic junction obstruction. Material and Methods: The data from patients who had standard laparoscopic pyeloplasty between January 2007 and January 2015 with a primary UPJ obstruction were examined. Comparative data from transperitoneal and retroperitoneal laparoscopic approaches were statistically analyzed. Results: Given the demographic and clinical characteristics of the patients 74 patients with transperitoneal, 38 patients with retroperitoneal surgery , there were no significant differences between the two groups. Mean operation duration was 149.52 minutes in the transperitoneal approach and 187.76 minutes in the retroperitoneal approach. Intracorporeal suturing was 66.4 minutes on average in the transperitoneal approach and 84.21 minutes in the retroperitoneal approach. The visual analogue scores, which were evaluated on postoperative days 1 and 2, the need for analgesics, and the length of stay in hospital were found to be higher in the group with LTPP compared to the LRPP group. One patient in each group had to undergo conversion to open surgery. Conclusion: The transperitoneal approach was found to be more advantageous than the retroperitoneal approach due to larger working area for the surgeon, easier and quicker intracorporeal suturing, easier control in the presence of aberrant blood vessels. On the other hand, the retroperitoneal approach was found to be superior to the transperitoneal approach with respect to gastrointestinal system findings, postoperative pain and shortness of the hospital stay duration. High rates of success were achieved in both groups in long-term follow-ups.

Keywords:

Pyeloplasty, transperitoneal, retroperitoneal, primary ureteropelvic junction obstruction,

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