Transperitoneal laparoscopic pyeloplasty in children and adolescents: Long-term results

Abstract

Background Open pyeloplasty has been the gold standard for the treatment of  ureteropelvic junction obstruction (UPJO) in children and young adolescents. However, the use of laparoscopy for the treatment of pyeloplasty is increasing as it has the potential to provide a better and more desirable cosmetic outcome in  addition to less postoperative pain and decreased recovery time. The aim of this study was to evaluate the long-term outcome of transperitoneal laparoscopic  pyeloplasty (TLP) for the treatment of UPJO in children and young adolescents.
Patients and methods Twenty-nine patients with UPJO with 32 renal units were subjected to TLP at Al-Azhar University Hospitals, Egypt, during the period from May 2008 to December 2012. The outcome measurements of this study included operative time, internal stent placement, hospital stay, intraoperative complications, and success rates. Success is defined as both symptomatic relief and radiographic resolution of hydronephrosis at the last follow-up. Patients were followed up with intravenous urography and diethylene triamine penta-acetic acid scan at 3, 6, and 12 months regularly for both functional and morphological outcomes.
Results The study included 29 patients (12 male and 17female) with 32 obstructed renal units. The mean age was  4.23 ± 2.1 years (range 3–16 years). All procedures were completed laparoscopically without conversion. The mean operative time was 143.41 ±23 min (range 110–220 min). The mean postoperative hospital stay was 4.1 days (range 3–8 days). All patients achieved full recovery without any complications. The mean follow-up period of the patients was 36.34± 5.18 months (range 22–60 months). Success rate was 96.9%. Only one case developed  recurrent UPJO and was treated with retrograde endopyelotomy and stenting.
Conclusion TLP has the advantages of less postoperative pain, short hospital stay, and rapid recovery, with excellent functional and cosmetic outcomes. However, it requires advanced skill level for intracorporeal suturing and knot tying.

Keywords: children, laparoscopy, long-term results, pyeloplasty, ureteropelvic junction obstruction