Abstract
We reviewed retrospectively the results of transperitoneal minilaparoscopic pyeloplasty in children younger than 2 years. The surgical technique utilized as well as the retrograde placement of the stent is described in detail. Twenty-four consecutive children with a mean age of 7.9 months (range 1–23), a mean weight of 7.4 kg (range 4–12), and a mean follow-up of 18 months (range 3–59) are included. Preoperative grade of dilatation was 3.8 (SFU scale) and postoperatively improved to 1.5. The AP diameter of the pelvis decreased from a mean of 28–9 mm. In 83% of cases, there was complete resolution of hydronephrosis (grades 0–2) and the rest showed improvement. There was one conversion to open surgery in a child with a horseshoe kidney. There was one omental prolapse though a port site in a child in whom an inappropriate drain was used. There were no stent-related complications and no reinterventions for persistent or recurrent obstruction. Given these outcomes, low complication rate and excellent cosmetic results, we recommend transperitoneal minilaparoscopy with a double J stent and a perirenal drain for infants requiring pyeloplasty.
Highlights
Laparoscopic pyeloplasty (LP) is well established as the preferred method to treat ureteropelvic junction obstruction (UPJO) in adults and older children
Minilaparoscopy in infants presents unique technical challenges given the limited working space available and the occasional difficulty encountered in stenting the anastomosis
The use of a perirenal drain offers the advantage of avoiding postoperative urine leak in the peritoneal cavity caused by a malfunctioning stent that often requires re-intervention
Summary
Laparoscopic pyeloplasty (LP) is well established as the preferred method to treat ureteropelvic junction obstruction (UPJO) in adults and older children. In some institutions, including ours, MLP is applied to children of all ages [1]. Open surgery continues to be preferred for younger children in some centers [2, 3]. In a recent survey, including children operated in the USA between 2004 and 2008, only 3.6% of children with UPJO were treated laparoscopically, underlining the technical difficulties of LP except in the hands of a few. We report a standard method of MLP that we evolved over the last 15 years [4], which has been applied at our institution since 2010 and is suited for small children. Since our method appears to differ substantially from widespread practices in several regards and our complication rate is low, we describe the technique in detail and the results obtained in 24 consecutive infants
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