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10.5005/jp-journals-10033-1292
Comparative Study of Surgical Approaches for Renal Pelvic Stones in a Northern Rural Medical College
OriginaL articLe

Comparative Study of Surgical Approaches for Renal

Pelvic Stones in a Northern Rural Medical College

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1 Bhanu P Sharma, Rikki Singal, Muzzafar Zaman, Karamjot Sandhu, Kamal Sharma, Rahul Yadav
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7 Preeti Grewal, Rajneesh K Mishra
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ABSTRACT Keywords: Laparoscopy, Open method, Pyelolithotomy, Renal
stone, Stone.
Introduction: Retroperitoneal pyelolithotomy (RPL) can be
used as an alternative to open pyelolithotomy (OP) when How to cite this article: Sharma BP, Singal R, Zaman M,
other modalities of stone removal fail. This procedure even Sandhu K, Sharma K, Yadav R, Grewal P, Mishra RK. Compara-
has potential to replace noninvasive techniques in selective tive Study of Surgical Approaches for Renal Pelvic Stones in a
subsets of patients. Northern Rural Medical College. World J Lap Surg 2017;10(1):1-7.
Aims and objectives: The aim of this study was to study the
efficacy, safety, and outcome of retroperitoneal laparoscopic Source of support: Nil
pyelolithotomy. The study compared the advantages and Conflict of interest: None
complications of RPL and OP.
Materials and methods: This study was conducted in the
Department of Surgery, Maharishi Markandeshwar Institute INTRODUCTION
of Medical Science and Research, Maharishi Markandeshwar
University, Ambala, from January 2012 to December 2015. A Treatment options for kidney stones are possible with
total of 280 patients of solitary renal pelvic stone were selected, noninvasive or minimally invasive approach including
out of whom 160 who underwent RPL were considered in shock wave lithotripsy, ureteroscopy, or percutane-
group I and 120 patients who underwent OP were considered in
group II. The patients included were of age group 12 to 80 years, ous nephrolithotomy (PCNL). There are considerable
with unilateral and bilateral solitary renal pelvis calculus and improvements in laparoscopic surgical techniques to
stone size of 10 mm to 3 cm. Patients with recurrent or residual the point that nearly any open surgery can be per-
stones after pyelolithotomy, intractable urinary tract infec- formed in a minimally invasive laparoscopic fashion.
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tion, and having extrarenal pelvis and any anatomical renal
abnormalities were excluded from the study. For patients with ectopic kidney, the results of extra-
Results: In this study, mean age was 37.1 and 46.66 years corporeal shock wave lithotripsy (ESWL) are only mod-
in groups I and II respectively. Male to female ratio was 2.33:1. erately successful and PCNL is difficult. Laparoscopic
Mean operative time was 75.33 ± 16.90 and 65.83 ± 12.35 minutes pyelolithotomy (LPL) is a viable alternative in such a
respectively, in groups I and II respectively (p < 0.001).
Pyelotomy closure time and Double-J (DJ) stent insertion situation. Lithiasis in kidneys that have some type of
time were 5.2 minutes (with standard deviation [SD] of 4.3) anatomical alteration is a particularly great challenge
and 9.8 (with SD of 3.7) respectively, in group I as compared for the urologist, due to the fact that the abnormal
with 4.2 minutes (with SD of 2.7) and 6.1 (with SD of 2.9) in
group II. Mean hospital stay was less in group I at 3.76 ± 0.85 anatomy prevents the use of the same disintegration
days and, in group II, it was 5.36 ± 1.96 days (p < 0.001). or extraction access routes that are utilized in normal
Postoperative anesthesia requirement was 2.23 ± 0.62 days kidney units. 2
(339 ± 93 mg) and 5.36 ± 0.96 days (804 ± 144 mg) in groups I
and II respectively (p < 0.001). The reports suggest that retroperitoneal laparoscopic
Conclusion: The RPL is a noninvasive and cost-effective pyelolithotomy (RLP), having procedural similarity to
method along with minimal scar mark. It has the advantages open pyelolithotomy (OP), is not only nephron sparing,
over OP of having fewer complications, less postoperative pain, but also nephron reviving and, consequently, could
better cosmesis, and less hospital stay.
eventually become accepted as the procedure of choice in
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selected groups of patients with renal calculus disease.
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1,6,7 Resident, Professor, Assistant Professor, Senior Resident Laparoscopic pyelolithotomy is the procedure of choice in
8 Chief certain conditions, i.e., the size of the stone, the need for
1-4,6,7 Department of Surgery, Maharishi Markandeshwer Institute concomitant open surgery, and inaccessibility to ESWL
of Medical Sciences and Research, Mullana, Haryana, India or PCN. Other indications are relative and include failure
5 Department of Urology, Maharishi Markandeshwer Institute of stone clearance via PCN, ureteroscopy, or ESWL due
of Medical Sciences and Research, Mullana, Haryana, India to difficult extraction, stone composition (i.e., cystine),
8 World Laparoscopy Hospital, Gurugram, Haryana, India or anatomy (i.e., ectopic, pelvic, or horseshoe kidney).
Corresponding Author: Rikki Singal, Professor, Dr. Kundan Pyelolithotomy is also indicated in combination with
Lal Hospital, Ahmedgarh, Punjab, India, e-mail: singalsurgery@ pyeloplasty without increasing morbidity or decreasing
yahoo.com
the success rate. 4
World Journal of Laparoscopic Surgery, January-April 2017;10(1):1-7 1