LAPAROSCOPIC TRANSPERITONEAL PYELOPLASTY FORURETEROPELVIC JUNCTION OBSTRUCTION IN PAEDIATRICPOPULATIONGROUP

Abstract

Background: The ureteropelvic junction obstruction (UPJO) is one of the most prevalent genitourinaryabnormalities in children. PUJO is considered as the most common cause of congenital hydronephrosis.Pyeloplasty is the main treatment method for patients with UPJO [5]. An ideal treatment should have thehighest success rate and be minimally invasive. There are many techniques for PUJO repair, but theDismembered AndersonHynes pyeloplasty remains thegoldstandardfor surgicalreconstruction[8].LaparoscopicAnderson-Hynes pyeloplasty has becomethegoldstandardinmanypediatriccenters Objectives: To assess the safety and efficacy of laparoscopic transperitoneal pyeloplasty in children withPUJ obstruction. Methods: The study included 30 consecutive cases of congenital unilateral PUJO with SRF <40% managedduring the 24-month period from November 2020 to November 2022. All the patients were properlyevaluated before proceeding for procedure. Results: In our study the mean age of patients was 6.4 years. Most of the children affected were males(76.7%) andinvolvement of left pelvi-ureteric junction. The commonest cause of pelvi-ureteric junctionobstruction was an abnormal proximal segment (53.3%) followed by crossing vessel (20%).Thepre-opAPPD on ultrasonography was in range from 21mm to 50mm, with a mean pre op APPD of 36.26mm.Most of the patients (83%) had a pre-operative differential renal function in the range of 31-40%(34.8%).Mean operative time was 99.06mins. Mean post op APPD was 27.38mmand DRF was 40.72%. 96% ofthe patients had an indwelling catheter in situ for a period of less than one week. Out of total 30 patientsanastomoticdrainwaskeptfor6daysin28patients(93.34%).Meanhospitalstayindays was7.53days. Conclusion:Laparoscopictransperitonealpyeloplastyisasafeandeffective,minimallyinvasiveprocedure in pediatric patients, characterized by good surgical efficiency, reduced complications, fasterrecoveryand satisfactory followup results.