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Laparoscopic dismembered pyeloplasty in children younger than 2 years
1Department of Pediatric Surgery, Women's and Children's Hospital, and University of Adelaide, North Adelaide, South Australia.
Insights
Laparoscopic pyeloplasty in children under two years old shows good outcomes. This minimally invasive surgery for ureteropelvic junction obstruction is effective in infants and toddlers.
Area of Science:
- Pediatric surgery
- Minimally invasive urologic procedures
- Pediatric urology
Background:
- Laparoscopic pyeloplasty has been established in older children since 1995.
- Reports on laparoscopic pyeloplasty in infants and toddlers are limited.
- Ureteropelvic junction obstruction is a common congenital anomaly.
Purpose of the Study:
- To evaluate the efficacy and outcomes of laparoscopic pyeloplasty in children younger than 2 years.
- To assess the feasibility of minimally invasive repair for ureteropelvic junction obstruction in infants.
- To compare results with established open surgical techniques.
Main Methods:
- Retrospective review of laparoscopic Anderson-Hynes pyeloplasties in children under 2 years old.
- Diagnosis confirmed by renal sonography and diuretic renogram.
- Transperitoneal laparoscopic approach with modifications; postoperative imaging for assessment.
Main Results:
- 11 patients (12 primary repairs) under 2 years underwent the procedure.
- 17% (2 patients) required a redo laparoscopic pyeloplasty.
- Successful drainage achieved in all patients post-procedure, with one showing improved drainage after redo surgery.
Conclusions:
- Laparoscopic pyeloplasty is a viable and effective option for young children.
- Minimally invasive repair of ureteropelvic junction obstruction can be safely performed in infants.
- Good functional outcomes can be achieved with this technique in the pediatric population.
Purpose:
Since the first laparoscopic pyeloplasty was described in a child in 1995, there have been several reports of pyeloplasty in older children. However, to date there have been few reports of laparoscopic pyeloplasty in infants and toddlers. The aim of this study was to evaluate the results of laparoscopic pyeloplasty in children younger than 2 years.
Materials And Methods:
All laparoscopic Anderson-Hynes pyeloplasties performed in children younger than 2 years were retrospectively reviewed. The diagnosis of ureteropelvic junction obstruction was confirmed on renal sonography and diuretic renogram. Laparoscopic pyeloplasties were performed via a transperitoneal route as originally described, with key modifications. All children were investigated with postoperative diuretic renogram and renal ultrasonography.
Results:
A total of 38 children with ureteropelvic junction obstruction underwent laparoscopic Anderson-Hynes pyeloplasty between January 2001 and December 2005. Of these patients 11 (7 males and 4 females) were younger than 2 years at surgery (median 1.4, range 2 to 22 months) and 1 had bilateral ureteropelvic junction obstruction, for a total of 12 primary repairs. However, 2 patients (17%) required redo laparoscopic pyeloplasty, for a total of 14 laparoscopic dismembered pyeloplasties in this age group. Operative time ranged from 70 to 140 minutes (mean 100) and median hospital stay was 2 days. Followup studies showed normal drainage in all patients except 1, who after redo pyeloplasty exhibited significantly improved but still prolonged drainage.
Conclusions:
This study suggests that laparoscopic pyeloplasty can now be performed in young children with good results.
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