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Laparoscopic trans-mesocolic pyeloplasty in children: initial experience from a center in India
Muneer Khan1, Shahnawaz Ahangar, Syed Sajjad Nazir
1Department of Surgery, Government Medical College, Srinagar, Kashmir, India.
Insights
Laparoscopic pyeloplasty using a trans-mesocolic approach is a safe and effective treatment for left-sided pelvi-ureteric junction obstruction in children. This minimally invasive technique offers good outcomes with reduced hospital stays and quick recovery.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Surgical Techniques
Background:
- Pelvi-ureteric junction (PUJ) obstruction is a common cause of hydronephrosis in children.
- Traditional open pyeloplasty can involve significant morbidity.
- Laparoscopic approaches offer potential benefits in terms of recovery and cosmesis.
Purpose of the Study:
- To evaluate the safety and efficacy of laparoscopic pyeloplasty via a trans-mesocolic approach in pediatric patients with left-sided PUJ obstruction.
- To assess post-operative outcomes including renal function, symptom resolution, and degree of hydronephrosis.
Main Methods:
- A retrospective review of 12 children (aged 5-16 years) who underwent laparoscopic pyeloplasty for left PUJ obstruction.
- The trans-mesocolic approach was used in all cases, with the Anderson Hynes technique.
- Post-operative assessment included isotope renal scans and ultrasound, with a mean follow-up of 12 months.
Main Results:
- All 12 procedures were completed successfully laparoscopically without conversion to open surgery.
- Mean operative time was 95 minutes, with average blood loss of 57 mL.
- Eleven patients were asymptomatic post-operatively; renal scans showed improved function in 10, and ultrasound confirmed reduced hydronephrosis in all cases.
Conclusions:
- Laparoscopic pyeloplasty via a trans-mesocolic approach is a safe and feasible option for treating left-sided PUJ obstruction in children.
- The technique demonstrates good functional and anatomical outcomes.
- This minimally invasive approach facilitates a shorter hospital stay and quicker return to daily activities.
Abstract:
The aim of the present study is to report our experience with laparoscopic pyeloplasty via trans-mesocolic approach in children with left pelvi-ureteric junction (PUJ) obstruction. Between May 2007 and May 2008, 12 children aged between five and 16 years, with documented PUJ obstruction on the left side, underwent laparoscopic pyeloplasty via trans-mesocolic approach. The outcome was assessed by post-operative isotope renal scan. The mean age of the study patients was eight years, ranging between five and 16 years. There were five males and seven females in the study. All children underwent Anderson Hynes Pyeloplasty by a single surgeon. All cases were stented with a JJ stent for a period of six weeks post-operatively. The procedures were completed successfully in all patients without need for conversion to open pyeloplasty in any patient. The mean operative time was 95 min, with a range of 80-140 min. The average blood loss was 57 mL. The mean hospital stay was 3.5 days with a range of 2.5 to six days. All children returned back to school within nine days following surgery. The mean follow-up period was 12 months (range, nine to 14 months). Eleven of the patients were completely asymptomatic, while one reported mild flank pain. All children underwent renal scans and renal ultrasound three months after stent removal. Ten had improved function on the scan while in one patient, the function remained the same and, in another, it showed obstructed response to diuretic, although the symptoms had improved. In all the cases, renal ultrasound showed a decrease in the severity of hydronephrosis by at least one degree. These results confirm that laparoscopic pyeloplasty by trans-mesocolic approach in children for left-sided PUJ obstruction is safe and feasible.
