Laparoscopic and Laparoscopic Assisted Pyeloplasty for Repair of Pelvi-Ureteric Junction Obstruction in Children

Abstract

Objectives: The aim of this study is to evaluate our experience in transperitoneal laparoscopic & laparoscopic assisted pyeloplasty in children with pelvi-ureteric junction obstruction. Methods: The data of all patients undergoing laparoscopic and laparoscopic assisted pyeloplasty at Queen Rania Hospital for Children, King Hussein Medical Center were retrospectively reviewed from prospectively collected data over four years (June 2009-2013). The medical records of 80 children who underwent transperitoneal laparoscopic and laparoscopic assisted Anderson Hynes dismembered pyeloplasty were reviewed. Results: The sample included 34 females and 46 males; the mean age was 6.4 years (range 2 months to 12 years). Out of the 80 patients, six underwent bilateral pyeloplasty in the same operation, two of whom had bilateral pyeloplasty for crossing vessels. Mean operating time for the totally laparoscopic pyeloplasty was 200 minutes (range 120-400), while for the laparoscopic assisted pyeloplasty was 70 minutes (range 50-95) (P<0.05). Hospital stay ranged from two to five days. There were no perioperative complications, no conversion to open pyeloplasty. Seventy four patients showed improvement of renal function after removal of JJ stent by ultrasound and diuretic dynamic renogram (MAG3) scan, six patients underwent balloon dilation for anastomotic stenosis three months post-operatively. Conclusion: Transperitoneal laparoscopic and laparoscopic assisted pyeloplasty in children are feasible, effective and safe techniques with minimal complications and give excellent long-term cosmetic and functional results. The hospital stay and convalescence are short and hence rapid return to normal activity is expected with less analgesia requirements. These procedures should be standardized and practiced in pediatric surgical units under the supervision of expert pediatric laparoscopic surgeons with high experience in pediatric urology to achieve the best outcome and learning curve.