Laparoscopic Pyeloplasty for Repair of Pelviureteric Junction Obstruction in Children

Abstract

The aim of this study was to report our initial experience with laparoscopic pyeloplasty (LP) in children with pelviureteric junction (PUJ) obstruction and describe the evolution and evaluate the results. We retrospectively reviewed the records of 32 consecutive infants and children with unilateral ureteropelvic junction obstruction and deterioration of renal function on isotope renography, who underwent LP (19 on the right, 13 on the left) between May 2003 and January 2007. Twenty-three were males and 9 females. The mean age was 7.7 years old (range, 2 months to 17 years); the patient was placed in a three quarter lateral position and three ports were used. The PUJ was resected and the anastomosis was made by using absorbable sutures. A JJ stent was inserted by laparoscopy in most patients. Follow-up included clinical and ultrasound assessment, followed by isotopic renography at 6 months. LP was feasible in 29 of 32 patients (91%). The procedure could not be completed by laparoscopy in 3 patients; the main reason was difficulty in completing the anastomosis. Only 1 patient with a big redundant renal pelvis underwent a reduction. Stent insertion was successful in all, except 1 patient. An aberrant crossing vessel was found in 12 patients. We held up the aberrant crossing vessel and PUJ with two- or three-point-not absorbable-sutures, without the needed pyeloplasty in 2 of them. The other 10 underwent a LP enabled ureteric transposition. Three patients presented with postoperative complications: pyelonephritis in 2 patients and PUJ leakage in 1 who underwent nephrostomy with a further uneventful course. Mean operative time was 152 minutes (range, 120-270), and average hospital stay was 4.7 days (range, 1-8). In 1 patient, cystoscopy showed that the JJ stent was not in the bladder at the time of removal, and ureteroscopy was used to retrieve it. Mean follow-up was 22 months (range, 2-56). A total of 29 patients (91%) were asymptomatic after removal of the double JJ stent, showing a reduction of the degree of hydronephrosis in all patients, and had also improved PUJ drainage on isotope renography or sonography. LP is effective and safe in children with minimal morbidity and gives excellent short-term results. The feasibility is also excellent in patients younger than 1 year. The transabdominal approach revealed good exposition without disadvantages for the patient.