The authors present a modified surgical technique during tumor nephrectomy in children with a conservative approach towards small bowel manipulation and cutting of the peritoneal reflections. We aimed to evaluate this modified surgical approach regarding the incidence of post-operative small bowel obstruction (SBO), and its technical utility.
The study includes all children with unilateral renal tumors who underwent radical nephrectomy and lymph nodes sampling at our tertiary center from 2010 to 2022. The modified technique was performed via the usual transverse incision. We cut the peritoneal reflections short of the cecum or short of the sigmoid colon. The colon is reflected over SB packing it, proceeding to nephrectomy and lymph nodes sampling. Data included demographics, clinical characteristics, treatment strategy, operative details, post-operative SBO, and overall outcomes.
The study included 890 patients with a median age of 3.2 years. The median tumor largest diameter was 13 cm (range: 9-18 cm). The modified surgical technique was adopted in 287 patients (32.3 %). Forty-three patients (43/890, 4.8 %) had post-operative SBO. Out of them, only 4 cases were operated on using the modified surgical technique (p-value<0.001). There were no significant differences between both techniques regarding timing of surgery, tumor rupture, lymph nodes sampling, and tumor size (p-value = 0.775, 0.328, 0.216, and 0.563, respectively).
The modified surgical approach is significantly correlated with lower incidence of post-operative SBO with no increased risk of tumor rupture or incomplete lymph nodes sampling. The timing of surgery or tumor characteristics had no significant impact on the technical utility of the modified surgical approach.
Level IV.
Journal of pediatric surgery. 2023 Nov 02 [Epub ahead of print]
Gehad Ahmed, Sayed Shaker Shaeir, Moatasem Elayadi, Naglaa Elkinaai, Amal Refaat, Azza Nasr, Ahmed Elgendy
General Surgery Department, Faculty of Medicine, Helwan University, Cairo, Egypt; Surgical Oncology Department, Children's Cancer Hospital, 57357, Cairo, Egypt., Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt., Pediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt; Pediatric Oncology Department, Children's Cancer Hospital, 57357, Cairo, Egypt., Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt; Pathology Department, Children's Cancer Hospital, 57357, Cairo, Egypt., Radio-Diagnosis Department, National Cancer Institute, Cairo University, Cairo, Egypt; Radio-Diagnosis Department, Children's Cancer Hospital, 57357, Cairo, Egypt., Radiotherapy Department, National Cancer Institute, Cairo University, Cairo, Egypt; Radiotherapy Department, Children's Cancer Hospital, 57357, Cairo, Egypt., Surgical Oncology Unit, Department of Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt. Electronic address: .