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Transmesenteric Laparoscopic Pyeloplasty in Trendelenburg Position for Horseshoe Kidney with Hydronephrosis
Published on: July 8, 2025
Laparoscopic transabdominal pyeloplasty in children is feasible irrespective of age
M L Metzelder1, F Schier, C Petersen
1Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany. metzelm@web.de
Insights
Laparoscopic transabdominal dismembered pyeloplasty is a safe and effective procedure for infants and children, including those under one year old. This minimally invasive technique demonstrates excellent feasibility and outcomes for treating ureteropelvic junction obstruction.
Area of Science:
- Pediatric Surgery
- Urology
- Minimally Invasive Surgery
Background:
- Ureteropelvic junction (UPJ) obstruction is a common cause of hydronephrosis in children.
- Dismembered pyeloplasty is the gold standard surgical treatment.
- Laparoscopic approaches offer potential benefits over open surgery.
Purpose of the Study:
- To assess the feasibility of laparoscopic transabdominal dismembered pyeloplasty in infants and children.
- To evaluate the impact of patient age on the procedure's success.
- To determine the safety and efficacy of this minimally invasive technique.
Main Methods:
- A consecutive series of 46 infants and children underwent laparoscopic transabdominal dismembered pyeloplasty.
- Patients were stratified into three age groups: 1-12 months, 1-7 years, and 7-18 years.
- Follow-up included clinical assessment, ultrasound, and isotope renography.
Main Results:
- The procedure was feasible in 96% of patients (44/46).
- Mean operative time was similar across all age groups.
- 96% of patients were asymptomatic with improved drainage post-operatively; two required re-operation.
Conclusions:
- Laparoscopic transabdominal dismembered pyeloplasty is effective and safe for pediatric UPJ obstruction.
- The transabdominal approach provides excellent exposure and is well-tolerated by young patients.
- Feasibility is high, even in infants under one year of age.
Purpose:
We assessed the feasibility of laparoscopic transabdominal dismembered pyeloplasty in 46 infants and children with regard to patient age.
Materials And Methods:
A total of 46 consecutive infants and children (31 male and 15 female) underwent laparoscopic transabdominal dismembered pyeloplasty using a 3 to 4-trocar technique. All patients had confirmed unilateral deterioration of renal function on isotope renography. The 46 patients were divided into 3 age groups--1 to 12 months (group 1, 14 patients), 1 to 7 years (group 2, 15 patients) and 7 to 18 years (group 3, 17 patients). Followup included clinical and ultrasound assessment, and isotope renography at 3 months.
Results:
Laparoscopic pyeloplasty was feasible in 44 of 46 patients (96%). Mean operative time was 175 minutes (range 120 to 270). The operation was converted due to impracticality of stenting the PUJ in 1 patient, and due to bleeding in 1. Mean operative time in 44 successful laparoscopic procedures was not significantly different among the 3 age groups (171 minutes in group 1, 169 minutes in group 2 and 173 minutes in group 3). Two patients required operative intervention for PUJ leakage, and 1 underwent percutaneous nephrostomy with a further uneventful course. Mean followup was 29 months (range 3 to 86). A total of 44 patients (96%) were asymptomatic and had improved PUJ drainage on isotope renography. Two patients underwent redo pyeloplasty due to recurrent hydronephrosis at 1 month and 2 years.
Conclusions:
Laparoscopic transabdominal dismembered pyeloplasty is effective and safe in infants and children. The feasibility is also excellent in patients younger than 1 year. The transabdominal approach revealed good exposition without a disadvantage for the patient.
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