Pyeloplasty laparoscopy is a minimally invasive procedure used to repair scarring or restriction at the ureteropelvic junction (UPJ).
This procedure is designed to clear a blockage or narrowing in the ureter. Compared to open surgery, laparoscopic pyeloplasty is safe and causes less discomfort. In addition, it has a shorter hospital stay, lesser risk factors, early return to everyday activities, and a more attractive cosmetic result.
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How is pyeloplasty laparoscopy performed? Before, during and after.
The patient is asked to get admitted to the hospital a day prior or on the same day of surgery. The doctor will perform a thorough body examination and laboratory investigations before surgery. The patient is administered with general anaesthesia before the surgery.Â
Five small incisions are made on the flank, each about 1-cm long. These incisions are used to pass long thin instruments during surgery. The abdomen is first filled with carbon dioxide which allows visualisation during surgery. The urologist gets an image of the abdomen via a webcam. The other apertures are cutting and suturing equipment to localise and remove the stricture, and the two remaining ends of the stricture can be stitched together. The procedure usually takes three to four hours to complete.Â
A wound drain is then implanted to drain any oozing from the area. It’s stitched in place and attached to a drainage bag that removes any urine or blood from the kidney. In addition, a ureteric stent is inserted. The stent promotes healing and also drains urine from the kidney.
A catheter (a flexible drainage tube) is also inserted into the urethra to drain urine from the bladder into a bag. It remains in place until physical activities can be resumed.
Surgery can take 2 to 4 hours, depending on the location and duration of the stricture.Â
A laparoscopic procedure requires 1–2 nights of hospital stay.
The cost of surgery in India
Rs. 1,70,000
The cost of surgery in Hyderabad
Rs. 1,59,000
Number of days in the hospitalÂ
2–3 days
Type of surgery
Minor
Anaesthesia typeÂ
general
Recovery time
3–4 weeks
Duration of the procedure
2–3 hours
Type of surgery
Minimally invasive laparoscopy
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Risks and complications
Although this surgery has proven to be safe; there are risk factors and potential complications of the surgical procedure. Following are some of the possible complications:
Bleeding
Blood loss is usually modest (less than 100 ccs) during this treatment, and a blood transfusion is rarely necessary.Â
Infection
All patients are given broad-spectrum intravenous antibiotics before surgery to reduce the risk of infection.Â
Hernia
Hernias at incision sites are uncommon because all keyhole incisions are meticulously closed at the end of the procedure.
Conversion to open surgery
If the pyeloplasty laparoscopic technique proves to be too challenging, the procedure could be converted to a traditional open operation.
Frequently Asked Questions about Laparoscopic Pyeloplasty
A pyeloplasty laparoscopic procedure may be required in both adults and children. Adults, teenagers, and older children can develop a UPJ obstruction and may need a pyeloplasty if their kidney is clogged. Males are twice as likely to be affected as females.Â
A UPJ blockage affects 1 in every 1500 babies.
A pyeloplasty laparoscopic procedure will be required if the problem does not improve after 18 months.
Pyeloplasty was traditionally performed as open surgery. But it is now possible to perform pyeloplasty as a laparoscopic procedure.
Laparoscopic pyeloplasty ensures minimal invasion and scarring. It also facilitates a quicker recovery time.
Yes. Pyeloplasty improves kidney function by placing a Blue Stent or JJ stent between the kidney and the ureter. This ensures better drainage from the kidney and an overall improvement in the performance of the kidneys.
The laparoscopic procedure for pyeloplasty takes 2 to 4 hours, depending on the steps involved in the surgery. It is performed under general anaesthesia. It is a minimally invasive procedure and offers a quicker recovery time.
It is usual for children to feel the need to urinate frequently after receiving a bladder catheter. In addition, children may feel some discomfort when urinating for the first few times. A damp, warm washcloth placed on the perineum may help your child to feel more at ease.
For up to 4 weeks after surgery, no heavy lifting or activity is allowed to avoid complications. Once the patient stops taking medication for pain and has a full range of motion at his waist, he can begin driving. Most patients can resume activities, including work after three to four weeks of surgery. The stent is removed after a few weeks of the surgery. It is an outpatient procedure completed on the same day. A drain may be implanted in the kidney and ureter to drain excess fluid during surgery and after surgery. The drain is removed from the bedside once the drainage stops.
Urinary incontinence that requires a Blue stent or JJ stent to be inserted between the kidney and the ureter would be best treated with laparoscopic surgery because it is minimally invasive and the procedure offers quick recovery.
The pain after laparoscopic pyeloplasty is minimal and does not last very long. One can resume work the very next day. The recovery period is shorter. If the pyeloplasty is performed as open surgery, the pain will remain until the incisions don’t heal and sutures are not removed. The removal of sutures could take 3 to 4 weeks.
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