Laparoscopic pyelopasty in breast-fed infants
Materials and methods. A total of 45 operations were made on 44 children aged 5.8 ± 3.8 months (group 1). Two-step pyeloplasty was performed in a child with bilateral hydronephrosis. Indications for surgery were grade III-IV hydronephrosis, impaired renal function, and clinical symptoms of obstruction. Postoperative complications were estimated in accordance with P.A.Clavien classification. Statistical analysis of surgery time, frequency of postoperative complications, and results of LP included comparison with the data on elder (8.7 ± 4.4 yr) children undergoing similar treatment (group 2). Results. LP was technically feasible in all children without conversions and complications. LP duration was not significantly different in groups 1 and 2 (50-180 and 60-240 min respectively). Grade 1 complications (Clavien classification) occurred in 4 patients of group 1 vs 10 ones in group 2 (p=0.2). In group 1 positive results were documented in 42 renal units; three patients developed post-LP concurrent stenosis of the ureterovesical segment that required laparoscopic reimplantation of the ureter. Recurrent obstruction occurred in two patients of group 2. Conclusion. LP is technically feasible in breast-fed babies with the minimal risk of complications; its duration is similar to that in elder children.