CODE: 17 - Comparative evaluation of laparoscopic transperitoneal and retroperitoneal approach (LP) in urological diseases in children
Article published in Urologia Polska 2006/59/Suplement 1.
Mieczysław Fryczkowski, Jacek Huk, Andrzej Paradysz, Ryszard Zbroński
- Katedra i Klinika Urologii w Zabrzu ¦l±skiej Akademii Medycznej w Katowicach
- Objectives. Introducing LP for treatment of urological diseases in children decreased both physical and psychological trauma connected with open procedures. Many publications revealed that retroperitoneal approach is much safer and produces lower costs, although requires a lot of experience in laparoscopy.
- Materials and methods. Between 1996 and 2005 year we performed 154 LP in children aged from 18 months to 18 years (mean 11.2 year). In 128 (83.1%) transperitoneal approach (TPA) was administered (I group) and in 26 (16.9%) retroperitoneal (RPA; II group). I group was devided into Ia - 81 (52.6%) children who underwent laparoscopic varicocelectomy and Ib-(30.5%) children with other urological diseases. For objective evaluation of results we used Polish score of operative difficulty (PSPOTOL). We analysed 11 different LP. Estimation of results depending on the age of children was also made. Follow-up ranged from 3 to 121 months after surgery (mean 55.8 months)
- Results. We observed shortest operation time, hospitalization, reconvalescence, conversion and reoperation rate and complications in group Ia with lowest PSPOTOL score. In group II we noticed better results than in group Ib with Similar PSPOTOL score. In youngest children there was highest PSPOTOL score and better LP results than in older children. Complication and conversion rate in particular operation type was PSPOTOL - dependent except for 2 children.
- Conclusions. 1. Retroperitoneal LP reveal better results than transperitoneal procedures in similar level of PSPOTOL score. TPA connected with varicocele riverse the score. 2. With exception for individual cases regardless to surgical approach PSPOTOL corelates with operation results. 3. PSPOTOL score is proportional to children's age who underwent LP and correlates with conversion, complications and reoperation ratio.