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18584

Robotic Assisted Laparoscopic Pyeloplast In Obese and Non-Obese Patients

Saturday, October 20, 2012
Grand Ballroom A/B (Hilton Riverside)
Bruce W. Lindgren, M.D., FAAP1, Brenden Frainey, M.S.1 and Edward M. Gong, M.D.2, (1)Urology, Children's Memorial Hospital, Chicago, IL, (2)Urology, Children's Hospital of Chicago, Chicago, IL

Purpose

Childhood obesity prevalence has nearly tripled over the last 3 decades.  Obesity has been shown to be a negative risk factor for adult surgery.  This has not been well studied in the pediatric population.  We compare outcomes between pediatric patients undergoing robotic assisted laparoscopic pyeloplasty (RALP) with and without childhood obesity.

Methods

Between October 2009 and January 2012, 108 robotic assisted laparoscopic surgeries were performed at our institution.  We retrospectively identified the last 50 consecutive patients who underwent RALP with IRB approval for research analysis.  Patients were separated into overweight and normal weight cohorts using 85th percentile of BMI (WHO criteria) as a cut-off for overweight.  Surgical and post-surgical outcomes were evaluated.  Complications were categorized using the Dindo-Clavien scale.

Results

Of the 50 patients, 37 were considered normal weight (BMI <85%ile for age) and 13 were considered overweight (BMI >= 85%ile for age).  The two cohorts were similar in respect to age, sex, follow-up, laterality, and prior renal procedures.   Operative time (235 min vs. 245 m, p=.0995), EBL (7.0 ml vs. 4.6 ml, p=0.098), length of stay (1.2 d vs. 1.2 d, p=0.803, and morphine equivalent narcotic analgesic administration 4.5 vs 3.1 mg, p=0.214) were similar between normal weight and overweight children, respectively.  Complication rates were similar in regard to minor (15.6% vs. 30.8%, p=0.411) and major (12.5% vs. 0%, p=0.308) complications between the normal and overweight cohorts, respectively.  Finally, there was no difference in sonographic evidence of decreased hydronephrosis (89.3% vs. 90.9%, p=1.000).  Only one patient required a re-operative procedure.  This was a patient in the normal weight cohort.

Conclusion

Despite the known difficulties with surgery in overweight patients, robotic-assisted laparoscopic pyeloplasty can be performed as safely and effectively in children who are overweight as in normal weight children.