Laparoscopic pyeloplasty using the postanastomotic dismemberment method: technique and results

Area of Science:

• Urology
• Minimally Invasive Surgery
• Pediatric Surgery

Background:

• Laparoscopic dismembered Anderson-Hynes pyeloplasty (AH) has excellent results but a steep learning curve.
• Laparoscopic nondismembered pyeloplasty is simpler but less effective than AH.
• A modified technique, postanastomotic dismemberment (PAD) pyeloplasty, aims to combine the benefits of both.

Purpose of the Study:

• To describe the procedure and outcomes of laparoscopic PAD pyeloplasty for primary ureteropelvic junction (UPJ) obstruction.
• To evaluate the technical ease and efficacy of the PAD technique.

Main Methods:

• The PAD technique involves partial pelvic division and ureteral spatulation before completing the anastomosis and pelvic reduction.
• Forty-one PAD procedures were performed on 40 patients with UPJ obstruction.
• Follow-up was at least 3 months, with detailed evaluation of operative parameters and outcomes.

Main Results:

• Mean operative time was 97.6 minutes with minimal blood loss and short hospital stay.
• Success rate was 95.1% with low complication rates.
• Procedure was effective across various UPJ configurations, stenosis lengths, and age groups.

Conclusions:

• Laparoscopic PAD pyeloplasty offers practical advantages, including a shorter operative time.
• The technique combines the technical ease of nondismembered procedures with the excellent outcomes of dismembered pyeloplasty.
• PAD pyeloplasty is a viable alternative for treating primary UPJ obstruction.