Results

For open calyceal diverticulectomy, success is the rule (2). Laparoscopic calyceal diver-ticulectomy replicates the techniques and principles of the open surgical approach. As such, symptom-free, stone-free, and "diverticulum-free" rates in reported series are 100%, 100%, and 93%, respectively, albeit with very short follow-up (Table 4) (18-24).

In one patient, a residual diverticulum was noted on follow-up intravenous pyel-ograms, measuring only 10% of the original lesion (20). The authors noted that the diverticular cavity was fulgurated but not filled with fat tissue in this case; all subsequent cases involved obliterating the diverticulum with fat tissue, and no recurrences were noted.

Overall morbidity is low with laparoscopic calyceal diverticulectomy. Operative time is about three hours, and hospital stay is generally two to three days. Complications were minor, including subcutaneous emphysema, self-limited fluid leak, and a three-unit blood transfusion, occurring in one patient each (Table 4).

TABLE4 ■ Reported Results After Laparoscopic Management of Symptomatic Caliceal Diverticuli, Including Complications, Stone-Free and Symptom-Free Rates, and the Rate of Persistence of the Diverticulum

Series Operative (patients) time (min)

Hospital stay (days)

Follow-up exam (months)

Stone-free (%)

Symptom-free (%)

Persistent diverticulum

(%)

Complications

Gluckman et al. (21) (N = 1) <180

3

IVF (N/A)

100

100

0

Subcutaneous emphysema

Ruckle et al. (22) (N = 1) N/A

3

IVF (2 mo)

100

100

0

None

Harewood et al. (19) 80-180

3-5

IVF (3-5 mo)

100

100

33a

Blood transfusion (N = 1)

(N = 3)

Port site fluid leak (N = 1)

Hoznek et al. (20) (N = 3) 60-90

5-9

CT scan (6 mo)

100

100

0

None

Curran et al. (23) (N = 1) 215

2

CT scan (4 mo)

100

100

0

None

Miller et al. (18) (N = 5) 90-200

0-5

IVF (1.5 mo)

100

100

0

None

aResidual diverticulum measuring 10% of original size, cavity not filled. Abbreviations: N/A, not available; IVR intravenous pyelogram; CT, computed tomography.

0 0

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