The BULT Method for Pediatric Minilaparoscopic Pyeloplasty in Infants: Technique and Results

Abstract

We reviewed retrospectively the results of transperitoneal minilaparoscopic pyeloplasty in children younger than 2 years. The surgical technique utilized as well as the retrograde placement of the stent is described in detail. Twenty-four consecutive children with a mean age of 7.9 months (range 1-23), a mean weight of 7.4 kg (range 4-12), and a mean follow-up of 18 months (range 3-59) are included. Preoperative grade of dilatation was 3.8 (SFU scale) and postoperatively improved to 1.5. The AP diameter of the pelvis decreased from a mean of 28-9 mm. In 83% of cases, there was complete resolution of hydronephrosis (grades 0-2) and the rest showed improvement. There was one conversion to open surgery in a child with a horseshoe kidney. There was one omental prolapse though a port site in a child in whom an inappropriate drain was used. There were no stent-related complications and no reinterventions for persistent or recurrent obstruction. Given these outcomes, low complication rate and excellent cosmetic results, we recommend transperitoneal minilaparoscopy with a double J stent and a perirenal drain for infants requiring pyeloplasty.

Is Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction in Infants Under 1 Year of Age a Good Option?

“…Late complications rate (two patients −3.4%) are similar to the literature (2–4, 25, 27). Malrotated kidneys remain a challenge because of the unexpected position and technical difficulties, like in 1 of our cases.…”

The outcomes of mini-laparoscopic pyeloplasty in children - brazilian experience

“…Although most series report longer operative time in LP, (mean 155-240min) (3,8,11,16) we had spent a mean of 107min., which may be near the open procedures time. Previous adult experience, same team, routine and focusing on simplifying every step certainly play a role in the operative time.…”

“…Since then, a few pediatric large se- Conversion to open procedure 0 (8). However, while early series had reported anastomotic stenosis in babies (9,10), subsequent studies demonstrated feasibility irrespective of patient age and weight (6,7,(11)(12)(13). LP has been thought to be a technically challenging procedure in children.…”

“…Many reference centers do not have programs to perform LP in young children-less than 2-3 years old ( 8 ). However, while early series had reported anastomotic stenosis in babies ( 9 , 10 ), subsequent studies demonstrated feasibility irrespective of patient age and weight ( 6 , 7 , 11 - 13 ).…”

A modification with threading cannula needle-assisted 4-point suspension fixation for retroperitoneal laparoscopic pyeloplasty in children with ureteropelvic junction obstruction: a cohort study in single center

“…However, since the operable space in a children’s body is small for laparoscopy, performing precise anastomotic suturing is restricted and the duration of operation is longer than OP, especially in LDP by retroperitoneal approach [6, 7]. Furthermore, it is easy to cause accidental damage to the surrounding tissues, resulting in bleeding and an increased risk for anastomotic stenosis for LDP in children [8].…”