EFFICACY AND SAFETY OF LAPAROSCOPIC PYELOPLASTY IN CHILDREN

Abstract

Uretero-pelvic junction obstruction is the most common cause of hydronephrosis in children. Surgical treatment has traditionally been in the form of open pyeloplasty. Less invasive methods including endoscopic and laparoscopic approaches were described. Endourological approaches did not allow proper reconstruction of the uretero-pelvic junction, and were not suitable for complicated uretero-pelvic junction obstruction such as in infants and children with a large, redundant renal pelvis or with crossing lower pole renal vessels. Laparoscopic pyeloplasty on the other hand is reportedly comparable and possibly superior to open pyeloplasty in adults, while data in children were until recently limited.

We present in this work the results observed in 2 centers of excellence in pediatric urology, with a large number of patients (181 children with 193 renal units). We found that the operation could be done using the same surgical principles as open surgery.

In all cases dismembered pyeloplasty was performed in standard fashion, spatulating the ureter after excision of the uretero-pelvic junction stricture, and reduction of redundant renal pelvis as necessary. After pyeloplasty ultrasonography with or without diuretic scintigraphic renography were obtained to document surgical success. We had an overall success rate of 96.4% defined by resolution of symptoms, better urinary drainage and improved renal function.

In our experience, repairing the UPJ obstruction in infants and children laparoscopically using transperitoneal dismembered pyeloplasty or other variations, allows the performance of precise anastomosis. The same good basic surgical principles like minimal handling of the ureteral or pelvic mucosa as in open surgery can be applied. Our study showed the safety and feasibility of laparoscopic pyeloplasty, offering a good outcome, minimal complications, an acceptable safe operative time, and short hospital stay.