Laparoscopic dismembered pyeloplasty for ureteropelvic junction obstruction in children

To present our initial experience with laparoscopic pyeloplasty and to evaluate the safety and short-term outcome of this technique in children.

Thirteen kidney units in twelve children underwent laparoscopic dismembered pyeloplasty for the management of ureteropelvic junction obstruction (UPJO) at our institution between 2005 and 2008. Patient age at surgery was 18-177 months (mean 89.8 months). There were six boys and six girls. Ten had unilateral UPJO with a normal contralateral kidney, one had bilateral UPJO and one had UPJO of a solitary kidney. We used 3- and 5-mm instruments for grasping, blunt dissection, incising and suturing to facilitate safe and precise surgery. The outcome was measured by the operative time and resolution of obstruction and symptoms.

Median operative time was 275 min (range 154-420). There was a slight relationship between age and operative time. No major perioperative complications occurred in any cases. Median renal pelvic anterior-posterior diameter at ultrasonography significantly decreased from 8.6 cm (range 3.8-22.0) preoperatively to 3.9 cm (1.0-8.9) postoperatively (P < 0.05). The median pre- and postoperative split renal function on diuretic renography in unilateral cases was 37.3% (range 29.7-46.4) and 39.5% (27.8-48.0), respectively. Overall, successful resolution of UPJO was observed in 12 of 13 kidneys (92.3%).

Laparoscopic pyeloplasty represents a safe and effective option in the surgical treatment of children with UPJO.