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Transmesenteric Laparoscopic Pyeloplasty in Trendelenburg Position for Horseshoe Kidney with Hydronephrosis
Published on: July 8, 2025
Laparoscopic dismembered pyeloplasty in children
Mallikarjun Reddy1, R B Nerli, Rajeev Bashetty
1Department of Urology, Kles Kidney Foundation, Kles Hospital, Belgaum, India.
Insights
Laparoscopic Anderson-Hynes pyeloplasty is a safe and effective treatment for pediatric ureteropelvic junction obstruction, showing short-term improvements in hydronephrosis and renal function.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
Background:
- Ureteropelvic junction obstruction is the most common congenital urinary tract abnormality in children.
- Laparoscopic pyeloplasty offers a minimally invasive alternative to open surgery.
Purpose of the Study:
- To evaluate the safety and efficacy of laparoscopic Anderson-Hynes dismembered pyeloplasty in children.
- To report a series of pediatric patients undergoing this procedure.
Main Methods:
- Diagnosis of ureteropelvic junction obstruction confirmed by clinical evaluation, sonography, and scintigraphy.
- Laparoscopic Anderson-Hynes pyeloplasty performed using 3 or 4 ports.
- Postoperative follow-up included monitoring for urinary tract infections and repeat renal scintigraphy at 3 months.
Main Results:
- Sixteen children aged 5 months to 11 years underwent the procedure.
- No major intraoperative or postoperative complications were observed.
- One patient with a horseshoe kidney required temporary percutaneous nephrostomy placement.
Conclusions:
- Laparoscopic Anderson-Hynes pyeloplasty demonstrates promising short-term outcomes in children.
- Improvements in hydronephrosis and glomerular filtration rate were noted.
- Resolution of symptoms was achieved in all treated patients.
Purpose:
Ureteropelvic junction obstruction remains the most common obstructive uropathy in children. Although laparoscopic dismembered pyeloplasty was described in a child in 1993, there have been few reports of laparoscopic Anderson-Hynes dismembered pyeloplasty in children. We report on a series of children who underwent laparoscopic Anderson-Hynes dismembered pyeloplasty.
Materials And Methods:
The diagnosis of ureteropelvic junction obstruction was firmly established in all patients based on history, clinical examination, renal sonography and scintigraphy. Laparoscopic Anderson-Hynes pyeloplasty was performed using either 3 or 4 ports. Children were followed for urinary tract infection, and renogram was repeated at 3 months.
Results:
A total of 16 children 5 months to 11 years old underwent laparoscopic Anderson-Hynes pyeloplasty between July 2002 and December 2003. No major intraoperative or postoperative complications were noted. One child with horseshoe kidney had development of fever and tenderness on the operated side on postoperative day 4. A percutaneous nephrostomy tube was placed and was removed 2 weeks later.
Conclusions:
Laparoscopic Anderson-Hynes pyeloplasty in children is too new to assess long-term outcome adequately. However, our study reveals improved outcome in the short term in the form of improved hydronephrosis and improved glomerular filtration rate on renal scan, and resolution of symptoms in all children.
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