What is a laparoscopic pyeloplasty?
A laparoscopic pyeloplasty is a minimally invasive surgical procedure for correcting a kidney ureteropelvic junction obstruction. Laparoscopic pyeloplasty is suitable for patient with ureteropelvic junction obstruction of the kidney.
Who is an ideal candidate for Laparoscopic Pyeloplasty Surgery? If a patient 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 patient have a blood vessel which may cause ureteropelvic junction (UPJ) to kink or if patient have a stone that gets impacted in the upper part of ureter, then patient is an ideal candidate for Laparoscopic Pyeloplasty.
What to expect prior to the Laparoscopic Pyeloplasty surgery:
Once surgical date is secured, patient will receive a form along with a letter of explanation to take to patient’s primary care physician or family doctor in order to have the following preoperative testing done prior to surgery.
- Physical exam
- EKG (electrocardiogram)
- CBC (complete blood count)
- PT / PTT (blood coagulation profile)
- Comprehensive Metabolic Panel (blood chemistry profile)
- Urinalysis
Procedure of Laparoscopic Pyeloplasty Surgery:
Laparoscopic Pyeloplasty is performed under a general anesthetic. The typical length of the operation is 3-4 hours. The surgery is performed through 3 small (1cm) incisions made in the abdomen. A telescope and small instruments are inserted into the abdomen through these keyhole incisions, which allow the surgeon to repair the blockage without having to place his hands into the abdomen. A small plastic tube (called a ureteral stent) is left inside the ureter at the end of the procedure to bridge the pyeloplasty repair and help drain the kidney. This stent will remain in place for 4 weeks and is usually removed in the doctor’s office. A small drain will also be left exiting patient’s flank to drain away any fluid around the kidney and pyeloplasty repair.
What are the advantages of the procedure of Laparoscopic Pyeloplasty Surgery?
• Reduced hospital stay and faster healing
• Less postoperative pain and less need for pain medication
• Quicker return to normal activity and work
• Smaller incisions and less scarring
What to expect after the Laparoscopic Pyeloplasty Surgery:
During patient’s hospitalization
Immediately after the surgery patient will be taken to the recovery room and transferred to hospital room once patient is fully awake and patient’s vital signs are stable.
- Hospital Stay: The length of hospital stay for most patients is approximately 1-2 days.
- Diet: Patient can expect to have an intravenous catheter (IV) in for 1-2 days. (An IV is a small tube placed into patient’s vein so that patient can receive necessary fluids and stay well hydrated until patient is able to tolerate a diet; in addition it
provides a way to receive medication). Most patients are able to tolerate ice chips and small sips of liquids the day after surgery and regular food the next day. Once on a regular diet, pain medication can be given by mouth.
- Postoperative Pain: Pain medication can be controlled and delivered by the patient via an intravenous patient-controlled analgesia (PCA) pump or by injection (pain shot) administered by the nursing staff. Patient may experience some minor transient shoulder pain (1-2 days) related to the carbon dioxide gas used to inflate patient’s abdomen during the laparoscopic surgery.
- Nausea: Patient may experience some nausea related to the anesthesia or pain medication. Medication is available to treat persistent nausea.
- Urinary Catheter: Patient can expect to have a urinary catheter draining patient’s bladder (which is placed in the operating room while the patient is asleep) for approximately 2 days after the surgery. It is not uncommon to have blood-tinged urine for a few days after surgery.
- Drain: Patient will have a drain coming out of a small incision in side. This drain is placed in the operating room around the operative site to prevent blood and fluid from building up around the kidney and pyeloplasty repair. The drainage typically appears blood-tinged. It is usually removed the day the urinary catheter is removed. If persistent high volume drainage occurs, patient may have to go home with the drain and have it removed in doctor’s office.
- Fatigue is common and should subside within a few weeks following surgery.
- Incentive Spirometry: Patient will be expected to do some very simple breathing exercises to help prevent respiratory infections by using an incentive spirometry device (these exercises will be explained to patient during patient’s hospital stay). Coughing and deep breathing is an important part of patient’s recuperation and helps prevent pneumonia and other pulmonary complications.
- Ambulation: On the day after surgery it is very important to get out of bed and begin walking under the supervision of nurse or family member to help prevent blood clots from forming in patient’s legs. Patient can expect to have SCD’s (sequential compression devices) along with tight white stockings to prevent blood clots from forming in patient’s legs.
Constipation/Gas Cramps:
Patient may experience sluggish bowels for several days following surgery as a result of the anesthesia. Suppositories and stool softeners are usually given to help with this problem. Taking a teaspoon of mineral oil daily at home will also help to prevent constipation. Narcotic pain medication can also cause constipation and therefore patients are encouraged to discontinue any narcotic pain medication as soon after surgery as tolerated.
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