PD40-02 TRANSPERITONEAL LAPAROSCOPIC MANAGEMENT OF PELVI-URETERIC JUNCTION OBSTRUCTION WITH ASSOCIATED CONGENITAL ANOMALIES AND SECONDARY CALCULI:OUR TECHNIQUE AND EXPERIENCE

Abstract

INTRODUCTION AND OBJECTIVES: Open pyeloplasty has been thegoldstandard forureteropelvic junctionobstruction (UPJO) repair and achieves success rates exceeding 90%. Laparoscopic pyeloplasty (LP) provides a minimally invasive alternative to repair UPJO and has developedworldwide as the firstminimally option tomatch success rate of open pyeloplasty. We present our technique and clinical experience of transperitoneal laparoscopic pyeloplasty (LP) in ureteropelvic junction obstruction (UPJO) with associated congenital anomalies and secondary calculi METHODS: 150 consecutive patients underwent LP for UPJO performed by one surgeon from January 2102 to August 2015.81 patients had associated congenital anomalies and secondary calculi 11 Horseshoe kidney (5 also had secondary calculi),33 crossing vessels (2 patient having main renal artery and vein as crossing vessels),27 secondary calculi,10 lateral malrotation A four-port transperitoneal approach was used in all cases. Patient demographic and perioperative data were recorded prospectively. Outcome measures were demographic data, peri-operative data, complications and success rate at a mean follow-up of 12 months. RESULTS: The mean operative time was 175 minutes and average blood loss was 60 ml. There was no conversion to open surgery. Antegrade stenting was done in all the cases. There were 6(7.4%) complications namely hematuria in 3 patients and UTI in 3 patients. The mean drain removal was 2.1 days whereas the mean catheter removal and hospital stay was 3.1 days for both. The mean follow up was 15.1 months. The success rate in our cohort was 100% defined by resolution of symptoms and documentation of unobstructive drainage on intravenous pyelography and nuclear renogram at 3 months and 1 year. CONCLUSIONS: Transperitoneal LP is feasible with generally good results for managing UPJO even with associated congenital anomalies and secondary calculi with low morbidity, quick recovery and a durable success rate.