Marek Orkiszewski, Joanna Madej
- Katedra i Klinika Chirurgii Dziecięcej i Traumatologii Akademii Medycznej w Bydgoszczy
Kierownik katedry i kliniki: dr hab. Marek Orkiszewski
dorsal lumbotomy, hydronephrosis, nephrectomy
- Dorsal lumbotomy has become the preferred method of approaching the kidney in the paediatric age group. It provides direct access to the kidney, spares muscles and nerves and is easy to learn. Recovery time is considerably shortened as is the use of analgesics too.
- It was the aim of this study to critically look at own experience with dorsal lumbotomy in pyeloplasty and nephrectomy in children.
- material and methods
- Dorsal lumbotomy approach was used in 21 operations in 19 patients aged 3 mth to 16.5 yrs. It only involves incisions to the Latissimus dorsi aponeurosis and lumbodorsal fascia with muscle retracting technique. It was used in 11 patients with ureteropelvic obstruction and in 7 patients with a nonfunctioning kidney.
- The approach proved easy and gave direct access to the pelvoureteric junction. It appeared easier with minimal retraction needed in infants than in older children. In one obese patient the pleura was inadvertently injured, where it crosses the middle of the twelve rib. In large hydronephrotic non-functioning kidneys, the access to vessels to the upper pole required incision of the costovertebral ligament cephalad. Closure of the incision is easy and requires only a few sutures to the fascia. Bleeding was minimal if any. The patients were ambulant on the second postoperative day with reduced parenteral analgesics.
- Dorsal lumbotomy is an easy approach to the kidney. It is more versatile in infants than in older age group. It provides the most direct access to the pelvoureteric junction.