Background: Open pyeloplasty was the standard procedure for congenital ureteropelvic junction (UPJ) obstruction in children, with overall success rates of 90% to 100%. Although endopyelotomy could be an alternative approach in children , the success of this procedure is inferior to conventional dismembered pyeloplasty. The operative time for laparoscopic pyeloplasty ranged from 3 to 7 hours, but the procedure has gradually gained more popularity and acceptance, with a reported success rate of over 95%. There are different laparoscopic techniques for pyeloplasty.
Aim: To report our initial results of laparoscopic pyeloplasty. We discuss technical tips and tricks with literature review.
Material &Methods: 14 patients aged from 9 months to five years. Two patients had aberrant crossing vessels and have Hitch back pyeloplasty. Eight retroperitoneoscopic pyeloplasty. Five out of eight were done lap assisted retroperitonoscopy. Six had laparoscopic transabdominal pyeloplasty Preoperative diagnostic studies included: US/ doppler scan, MAG3-renogram, MRU. No intraoperative diuretic-test was performed before and after the vessels transpositions to confirm the extrinsic- UPJO. Follow up of resolving hydronephrosis and improved renal function was assessed clinically and radiologically. As instruments we used an optical port of 5 with a 30° Camera and two 5-mm working ports. Pneumoperitoneum was induced with a 5–10 mmHg pressure CO2. Different stents were inserted including JJ-stent and blue stent.
Results: Operative time was 80 to 240 minutes. Hospital stay was 2 to four days. No major intra or post operative complications. Two out of three had prolonged ileus because of urinary leakage for more than 72 hours, and one was retroperitoneoscopic. During follow-up (range, 6 months to 12 years). All patients reported resolution of their symptoms, complete resolving of hydronephrosis and improved drainage on diuretic renogram.
Conclusion: We believe that laparoscopic pyeloplasty resulting in lower complication rate and a significantly reduced hospitalization. Depending on our limited number of cases and literature review we could conclude that laparoscopic pyeloplasty is safe, feasible, and more cosmetic alternative to treat obstructed hydronephrosis.
Keywords: Retroperitoneoscopy, Vascular hitch, Laparoscopic Pyeloplasty
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