Related Experiment Video
Updated: Mar 26, 2026
Transmesenteric Laparoscopic Pyeloplasty in Trendelenburg Position for Horseshoe Kidney with Hydronephrosis
Published on: July 8, 2025
Outcomes of Re-Intervention for Laparoscopic Transperitoneal Pyeloplasty in Children
Ling Leung1, Ivy Hau Yee Chan1, Patrick Ho Yu Chung1
1Division of Paediatric Surgery, Department of Surgery, The University of Hong Kong , Queen Mary Hospital, Hong Kong .
Insights
Re-intervention for failed pediatric laparoscopic pyeloplasty shows redo pyeloplasty is more effective than urinary diversion. Redo laparoscopic pyeloplasty improves differential renal function in children.
Area of Science:
- Pediatric Surgery
- Urology
- Minimally Invasive Surgery
Background:
- Management of failed laparoscopic pyeloplasty in pediatric patients lacks consensus.
- Limited publications exist on re-intervention outcomes for pediatric laparoscopic pyeloplasty.
Purpose of the Study:
- To evaluate clinical outcomes of re-intervention for failed laparoscopic transperitoneal pyeloplasty in infants and children.
- To compare the effectiveness of redo pyeloplasty versus urinary diversion for failed laparoscopic pyeloplasty.
Main Methods:
- Retrospective review of pediatric patients undergoing laparoscopic transperitoneal dismembered Anderson-Hynes pyeloplasty (2002-2013).
- Analysis of patient demographics, indications, operative details, and outcomes for primary and re-intervention procedures.
- Categorization of re-interventions into redo pyeloplasty and urinary diversion groups.
Main Results:
- Ten out of 42 patients (22%) required re-intervention for failed pyeloplasty.
- Indications for re-intervention included renal function deterioration, hydronephrosis, urinary ascites, and urosepsis.
- Redo pyeloplasty group (n=6) had a 50% success rate, while urinary diversion (n=4) had a 25% success rate. Redo laparoscopic pyeloplasty improved differential renal function by a median of 11%.
Conclusions:
- Laparoscopic transperitoneal pyeloplasty is safe and feasible in children.
- Redo pyeloplasty is a more favorable re-intervention strategy compared to urinary diversion for failed pediatric laparoscopic pyeloplasty.
- Redo laparoscopic pyeloplasty can effectively restore drainage and improve differential renal function.
Background:
There is no consensus for the management of failed laparoscopic pyeloplasty in pediatric surgical patients, and only limited publications are available. We evaluated here the clinical outcomes of re-intervention for failed laparoscopic transperitoneal pyeloplasty in infants and children.
Materials And Methods:
Retrospective review of all children who had undergone laparoscopic transperitoneal dismembered Anderson-Hynes pyeloplasty for ureteropelvic junction obstruction from 2002 to 2013 was performed. Patients' demographics, indications, operative details, and outcomes for primary operation as well as re-intervention were studied.
Results:
There were 42 patients with a median age of 20 months (range, 3-192 months) and a median body weight of 12 kg (range, 6-56 kg) who underwent a total of 46 laparoscopic transperitoneal pyeloplasties during the study period. The median operative time and blood loss were 193 minutes (range, 115-480 minutes) and trace amount (range, trace amount to 400 mL), respectively. No conversion was reported. Ten cases (22%) required re-intervention. No statistically significant risk factor for failed pyeloplasty was identified. Indications for re-intervention included deterioration of differential renal function (n = 6), progressive hydronephrosis (n = 1), urinary ascites (n = 2), and urosepsis (n = 1). Median time of re-intervention was 6.5 ± 38 months postpyeloplasty. Re-intervention was categorized into the redo pyeloplasty group (n = 6) and the urinary diversion group (n = 4) (insertion of double-J ureteral stent or endopyelotomy) with success rates of 50% and 25%, respectively. Among the redo pyeloplasty group, 3 patients underwent redo laparoscopic pyeloplasty, and all of them had drainage restored with a median improvement in differential renal function of 11%. The mean follow-up duration was 77 ± 38 months.
Conclusions:
Laparoscopic transperitoneal pyeloplasty is safe and feasible in children. Redo pyeloplasty is a more favorable re-intervention compared with urinary diversion in our series. Redo laparoscopic pyeloplasty has been shown to improve differential renal function.
