RESUMEN
PURPOSE: Open dismembered pyeloplasty is the preferred repair for ureteropelvic junction obstruction. Minimally invasive techniques have been applied to the original open approach but no clear advantage has been demonstrated for these technological advances. We evaluate outcomes between transperitoneal laparoscopic and open pyeloplasty in children. MATERIALS AND METHODS: All children 1 to 18 years old with ureteropelvic junction obstruction requiring operative repair were offered enrollment in the study. Patients were prospectively randomized to either laparoscopic or open pyeloplasty through a flank incision. RESULTS: A total of 50 patients in the laparoscopic group and 48 in the open group were enrolled from 2005 to 2014. Mean followup was similar between the groups (13.7 months in the laparoscopic group vs 12.3 months in the open group, p = 0.54). The only significantly different outcomes were for mean operative time, which was 139.5 minutes (range 94 to 213) in the laparoscopic group and 122.5 minutes (83 to 239) in the open group (p <0.01), and mean length of stay, which was 25.9 hours (18 to 143) in the laparoscopic group and 28.2 hours (16 to 73) in the open group (p = 0.02). Analgesic usage, success rate, total charges and all parameters in children older than 11 years were similar between the groups. CONCLUSIONS: Open and laparoscopic dismembered pyeloplasty are comparable and effective methods for repair of ureteropelvic junction obstruction. Although operative time was statistically shorter in the open group and length of stay was shorter in the laparoscopic group, the clinical significance of these variables is questionable. The approach to repair may best be based on family preference for incision aesthetics and surgeon comfort with either approach, rather than more classically objective outcome measures.
Asunto(s)
Pelvis Renal/cirugía , Laparoscopía , Obstrucción Ureteral/cirugía , Procedimientos Quirúrgicos Urológicos/métodos , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Estudios Prospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: Split-dose bowel preparations for colonoscopy have superior effectiveness compared with giving all the preparation the evening before colonoscopy. Some physicians believe that split-dose preparations would be unpopular with patients scheduled for early morning colonoscopies. AIMS: To determine the willingness of potential patients to undergo split-dose bowel preparation for colonoscopy and the actual adherence of colonoscopy patients to split-dose instructions. METHODS: We performed a survey of esophagogastroduodenoscopy patients and drivers of colonoscopy patients asking whether they would accept split-dose preparations for early morning colonoscopy appointments. We also asked colonoscopy patients scheduled in the early morning if they had complied with the written preparation instructions. RESULTS: Of the 300 individuals surveyed, the majority (85%) stated they would be willing to get up during the night to take the second dose of preparation. Of 107 colonoscopy patients with early morning appointments, 78% actually got up during the night to take the second dose of preparation. CONCLUSIONS: Acceptance of and compliance with split-dose bowel preparations is high and should not be a deterrent to prescribing split-dose preparations for colonoscopy.