What is a Laparoscopic Pyeloplasty ?
A Laparoscopic Pyeloplasty is a minimally invasive surgical procedure to correct a blockage or narrowing (puj obstruction) of the junction of the kidney to the tube draining urine.Why is Laparoscopic Pyeloplasty performed ?
Obstruction of the ureteropelvic junction (UPJ) can be caused by congenital abnormalities like horseshoe kidney, fibrous scarring due to stone or previous operation, a blood vessel which may cause it to kink or a stone that gets impacted in the upper part of ureter. This can cause damage to kidney tissue and eventually lead to pain, stones, infection, high blood pressure, deterioration of kidney function and kidney failure. Laparoscopic Pyeloplasty is the procedure of choice to relieve all these symptoms.
Who is an ideal candidate for Laparoscopic Pyeloplasty ?
If you have obstruction of the ureteropelvic junction (UPJ) which can be caused by congenital abnormalities like horseshoe kidney, fibrous scarring due to stone or previous operation, or if you have a blood vessel which may cause your ureteropelvic junction (UPJ) to kink or if you have a stone that gets impacted in the upper part of ureter, then you are an ideal candidate for Laparoscopic Pyeloplasty.
Preparation for surgery:
Medications to Avoid Prior to Surgery
Aspirin, Motrin, Ibuprofen, Advil, Alka Seltzer, Vitamin E, Ticlid, Coumadin, Lovenox, Celebrex, Voltaren, Vioxx, Plavix and some other arthritis medications can cause bleeding and should be avoided 1 week prior to the date of surgery (Please contact your surgeon’s office if you are unsure about which medications to stop prior to surgery. Do not stop any medication without contacting the prescribing doctor to get their approval).
Bowel Preparation and Clear Liquid Diet
Do not eat or drink anything after midnight the night before the surgery and drink one bottle of Magnesium Citrate (can be purchased at your local pharmacy) the evening before your surgery.Drink only clear fluids for a 24-hour period prior to the date of your surgery. Clear liquids are liquids that you are able to see through. Please follow the diet below.
Clear Liquid Diet
Remember not to eat or drink anything after midnight the evening before your surgery. Clear liquids are liquids that you are able to see through.
Please follow the diet below :
- Clear Broths (no cream soups, meat, noodles etc.)
- Chicken broth
- Beef broth
- Juices (no orange juice or tomato juice)
- Apple juice or apple cider
- Grape juice
- Cranberry juice
- Hawaiian punch
- Kool Aid
- Gator Aid
- Tea (you may add sweetener, but no cream or milk)
- Coffee (you may add sweetener, but no cream or milk)
- Clear Jello (without fruit)
- Popsicles (without fruit or cream)
- Italian ices or snowball (no marshmallow)
Q. How is the operation done ?
Figure : an illustration of the kidney and ureter before, during and following the procedure.
The first part of the operation is to give you an anaesthetic (put you to sleep) so that you will not be aware of anything whilst the operation is being performed.
The operation can take 3-4 hours, but can vary depending upon the individual. Three small cuts (approximately 1cm) are made in your stomach to perform the operation. A small plastic tube (stent) is placed inside the pipe leading from the kidney (ureter) at the beginning of the operation to bridge the surgical repair and help urine to drain freely from the kidney involved.
The tube will be left inside for 4-6 weeks and you will return as a day case to have this removed. This is done under local anaesthesia through the passage where you pass urine.
A tube (catheter) is placed into your bladder to allow urine to drain whilst you recover from your operation. The urine may have blood in it but this is normal and will clear in a day or two. The tube (catheter) will be removed once you are walking around, in a day or two.
You may also have a wound drain in your stomach to drain away any blood. This will be removed when there is little or no fluid draining from it.
Figure: Traditional open kidney surgery is performed through an 8-12 inch incision extending from the ribs towards the abdomen. A portion of one of the ribs is usually removed as part of the surgery.
Figure : An illustration of 3 incisions during the procedure
Advantages over open surgery
- Less pain
- Shorter hospital stay
- Quicker recovery
- Better cosmetic result
Q. What is the recovery period like following Laparoscopic Pyeloplasty ?
You will spend the next few hours following Laparoscopic Pyeloplasty, in the recovery room to monitor your vital signs and observe for any immediate post-operative complications. You will be hospitalized for 24 – 48 hours following Laparoscopic Pyeloplasty. Pain medication and antibiotics will be given post-operatively.
The stent will be removed 4 – 6 weeks after Laparoscopic Pyeloplasty. Avoid performing strenuous activities like lifting something heavy, jogging, treadmill or playing sports for at least 2 weeks after Laparoscopic Pyeloplasty. You will be instructed to move around, avoid getting constipated, do some very simple breathing exercises to help prevent respiratory infections. You will be able to perform all your routine daily activities in about 2 – 4 weeks time after Laparoscopic Pyeloplasty.
Potential Risks and Complications
Although this procedure has proven to be very safe, as in any surgical procedure there are risks and potential complications. The safety and complication rates are similar when compared to the open surgery.
Potential risks include : -
- Bleeding : – Blood loss during this procedure is typically minor (less than 100 cc) and a blood transfusion is rarely required. If you are still interested in autologous blood transfusion (donating your own blood) prior to your surgery, you must make your surgeon aware. When the packet of information is mailed or given to you regarding your surgery, you will receive an authorization form for you to take to the Red Cross in your area.
- Infection : – All patients are treated with broad-spectrum intravenous antibiotics prior to starting the surgery to decrease the chance of infection from occurring after surgery. If you develop any signs or symptoms of infection after the surgery (fever, drainage from your incision, urinary frequency, discomfort, pain or anything that you may be concerned about) please contact us at once.
- Hernia : – Hernias at incision sites rarely occur since all keyhole incisions are closed carefully at the completion of your surgery.
- Tissue / organ injury : – Although uncommon, possible injury to surrounding tissue and organs including bowel, vascular structures, spleen, liver, pancreas and gallbladder could require further surgery. Injury could occur to nerves or muscles related to positioning.
- Conversion to open surgery : – this surgical procedure may require conversion to the standard open operation if extreme difficulty is encountered during the laparoscopic procedure. This could result in a larger standard open incision and possibly a longer recuperation period.
- Failure to correct UPJ obstruction : – Roughly 3 % of patients undergoing this operation will have persistent blockage due to recurrent scarring. If this occurs additional surgery may be necessary.
Q. What is the outcome of Laparoscopic Pyeloplasty ?
Laparoscopic Pyeloplasty almost has a success rate of 95%, there is reduced hospital stay (one day in younger, healthy patients), faster healing and quicker return to normal activity and work.