Laparoscopic pyeloplasty in infants: single-surgeon experience

Area of Science:

• Pediatric Surgery
• Urology

Background:

• Laparoscopic pyeloplasty (LP) is widely used in children, but its application and outcomes in infants remain less defined.
• Infant LP is often presumed to be technically challenging with a higher risk of failure.

Purpose of the Study:

• To evaluate the safety and efficacy of laparoscopic pyeloplasty in infants.
• To test the hypothesis that LP can be performed successfully and safely in this young patient population.

Main Methods:

• Retrospective review of 111 infants undergoing LP between March 2009 and December 2013 with at least one year of follow-up.
• Analysis of pre- and postoperative imaging (ultrasound, diuretic renogram), operative details, and complications.
• Statistical comparison of pre- and postoperative parameters.

Main Results:

• LP was successfully completed in all infants using three ports, with no open conversions.
• A 12% complication rate was observed, with only 1% requiring re-intervention for re-obstruction.
• 99% of kidneys showed successful obstruction relief, with significant reduction in hydronephrosis (APD decreased from 34.4mm to 10.6mm) and improved split renal function in unilateral cases (22.1% to 35.6%).

Conclusions:

• Infant laparoscopic pyeloplasty is a safe and successful procedure.
• The technique leads to significant reduction in hydronephrosis and substantial functional improvement in infants.
• Outcomes are comparable to published results for open and robotic-assisted pyeloplasty.