Laparoscopic pyeloplasty in infants: single-surgeon experience
Related Experiment Video
Updated: Apr 8, 2026
Transmesenteric Laparoscopic Pyeloplasty in Trendelenburg Position for Horseshoe Kidney with Hydronephrosis
Published on: July 8, 2025
1Pediatric Surgery, Pediatric Urology & MAS, Rainbow Children's Hospitals, Hyderabad, Telangana, India.
Insights
Laparoscopic pyeloplasty (LP) is a safe and effective procedure for infants, demonstrating high success rates in relieving obstruction and improving kidney function. This minimally invasive approach offers comparable outcomes to open surgery with significant reduction in hydronephrosis.
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.
Introduction:
Although laparoscopic pyeloplasty (LP) is popular in children, its role in infants is less well defined. It is presumed that infant LP is technically challenging, with a higher failure rate.
Objective:
To consider the hypothesis that LP can be safely and successfully performed in infants.
Methods:
The records of 111 infants that underwent LP from March 2009 to December 2013 with at least 1 year of follow-up, were retrospectively reviewed. The results of pre- and postoperative imaging studies (ultrasound (US) and diuretic renogram (DR)), operative details and complications were noted. Pre- and postoperative parameters were compared using statistical software.
Results:
The details are given in the Table. Laparoscopic pyleoplasty was successfully completed using three ports in all children without any open conversions. There were complications in 14 children (12%); 13 did not require a second intervention and the final outcome was not affected. One child (1%) had a re-obstruction with worsening hydronephrosis (HDN) 2 months after stent removal; she underwent successful redo LP. Median follow-up was 2 years; LP was successful in relieving the obstruction in 115 kidneys (99%); all had follow-up US, while 76 children had follow-up DR. The tests showed significant reduction in HDN (mean pre-operative anteroposterior diameter (APD) of renal pelvis, 34.4 mm (SD 13.4) versus mean post-operative APD 10.6 mm (SD 5.7), p < 0.001) and improved drainage in all kidneys. In unilateral cases, there was significant improvement in mean split renal function (SRF) of the operated kidneys (pre-operative 22.1% (SD 8.6) versus post-operative 35.6% (SD 11.4), p < 0.001).
Discussion:
Over the past 6 years, all pyeloplasties at our unit have been performed by laparoscopy, irrespective of the age or weight of the child. In this large retrospective series, it is demonstrated that infant LP is a safe and successful operation; pyeloplasty in this age group not only resulted in significant reduction of hydronephrosis, but also in significant functional improvement. The results are comparable to published series comparing open pyeloplasty to laparoscopic and robotic-assisted laparoscopic pyeloplasty, which report success rates ranging from 70 to 96%, and complication rates ranging from 0 to 24% for open pyeloplasty.
