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Updated: Aug 20, 2026
Transmesenteric Laparoscopic Pyeloplasty in Trendelenburg Position for Horseshoe Kidney with Hydronephrosis
Published on: July 8, 2025
Comparison of dismembered and nondismembered laparoscopic pyeloplasty in the pediatric patient
Pasquale Casale1, Richard W Grady, Byron D Joyner
1Seattle Children's Hospital, University of Washington, 4800 Sand Point Way NE, PO Box 5371/63-1, Seattle, WA 98105-0371, USA. pat.casale@seattlechildrens.org
Background And Purpose:
Laparoscopic dismembered pyeloplasty is an acceptable option for ureteropelvic junction (UPS) obstruction in the pediatric population. We compared our results with dismembered and nondismembered laparoscopic pyeloplasty.
Patients And Methods:
A series of 26 children between the ages of 8 months and 15 years (mean age 5 years) underwent transperitoneal laparoscopic pyeloplasty for an obstruction not caused by a crossing vessel. Nineteen had an Anderson-Hynes dismembered pyeloplasty (AH), while the remaining seven had a nondismembered pyeloplasty in a Heineke-Mikulicz fashion (HM). The outcome measures were operative time, length of hospital stay, and resolution of obstruction by ultrasonography and diuretic radionuclide imaging.
Results:
The mean operative time was 3.1 hours and 2.5 hours for AH and HM, respectively. No difference in hospital stay was noted, with a mean of 3 days. The stent was removed 6 weeks later. Four of the seven patients having nondismembered procedures presented with acute flank pain within 3 days of stent removal. The AH pyeloplasty produced a 94% rate of resolution of UPJ obstruction, while the HM patients did poorly, with a success rate of only 43% (P = 0.002; Fisher's exact test).
Conclusions:
We believe that for UPJ obstructions in children not involving a crossing vessel, laparoscopic dismembered (AH) pyeloplasty may be considered a safe alternative.
