Comparação entre a ileocistoplastia convencional e assistida por laparoscopia : estudo experimental em suinos / Laparoscopic assisted versus conventional ileocystoplasty : an experimental study in pigs

AUTOR(ES)
DATA DE PUBLICAÇÃO

2009

RESUMO

Introduction: Based on the concept of less invasive surgical techniques, indications for video laparoscopy in Urology have grown and are well established either for ablative or reconstructive surgeries. The potential advantages of video laparoscopy are: less pain; shorter hospital stay; earlier recovery; biological advantages such as lower incidence of intraperitoneal adhesions, fewer stimuli to immunosuppression, smaller and more esthetic scars, less self-image aggression - especially in children. Laparoscopic reconstructive surgery takes longer than open surgery as it requires intracorporeal sutures. However, with the standardization of the operative technique and continuous training, it is possible to reduce duration, making it approximately the same as in an open surgery. Objective: Compare laparoscopic assisted ileocystoplasty with open ileocystoplasty in an experimental model in pigs, evaluating intraoperative aspects, postoperative recovery, development of peritoneal adhesions and functional results. Material and Methods: The study was conducted on 30 Large-white male pigs (20- 25Kg). The animals were divided into 4 groups. Group I (10 animals that underwent laparoscopic assisted ileocystoplasty), Group II ( 10 animals that underwent open surgery), Group III (5 animals underwent laparoscopy simulation) and Group IV (5 animals that underwent open surgery simulation). Studied variables were: total operative time, ileovesical anastomosis time, postoperative urodynamic results (bladder capacity and compliance), daily and weekly weight gain and intraperitonial adhesions (incidence and type, after animal sacrifice). Results: Mean operative time for groups I and II was 179.4 and 69.6 minutes respectively, and this difference was significant (p<0.05). Mean ileovesical anastomosis time had also significant difference (p<0.05) between groups I (74.8 min) and II (31.8 min). Significant differences were noted in mean weekly weight gain when comparing the first 4 weeks after surgery, Groups I (1st week: 384.7g ; 2nd week: 437.2g ; 3rd week: 493.6g and 4th week: 546.2g ) and II (1st week: 287.4g; 2nd week: 353.9g ; 3rd week: 417g and 4th week: 485.1g). Post operative bladder capacity and compliance differences among all groups were not significant (p>0.05). Overall incidence of intraperitoneal adhesions was not significant different in all groups (p>0.05). However, adhesions complexity and mean adherence "score" was higher in Group II (4.2 - open surgery) when compared to Groups I (2.8), III (2.0) and IV (2.0). This difference was significant (p<0.05). Conclusion: Laparoscopic assisted ileocystoplasty requires more surgical time than open surgery, but has significant advantages. Postoperative recovery is faster and intraperitoneal adhesions are less complex in laparoscopic assisted ileocystoplasty than conventional (open) surgery. Functional results are the same with open and laparoscopic assisted ileocystoplasty

ASSUNTO(S)

laparoscopy adhesion laparoscopia ileocystoplasty bladder augmentation aderencias ileo - cirurgia bexiga neurogenica

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