Laparoscopic Anderson-Hynes dismembered pyeloplasty in children

Abstract

Purpose: The feasibility and results of laparoscopic Anderson-Hynes dismembered pyeloplasty in children were evaluated.

Materials and methods: All laparoscopic Anderson-Hynes pyeloplasties performed by the author were retrospectively reviewed. A total of 18 children 3 months to 15 years old (mean age 17 months) with proved ureteropelvic junction obstruction underwent laparoscopic Anderson-Hynes dismembered pyeloplasty between August 1994 and June 1998. Of the 18 pyeloplasties 15 were performed in children who had not undergone previous upper tract surgery, and 3 had undergone previous upper tract surgery, including laparoscopic pyeloplasty in 2 and emergency percutaneous nephrostomy drainage of pyonephrosis 6 weeks earlier in 1. All operations were performed via a transperitoneal route.

Results: Postoperative evaluation is complete in 16 patients and pending in 2. Of the 16 patients 14 (87%) have no demonstrable evidence of obstruction. Two patients with persistent obstruction underwent repeat laparoscopic pyeloplasty. There was no conversion to open surgery. Mean operative time was 89 minutes. In 1 patient trocar hematoma resolved with bed rest. In another case the stent was misplaced with its distal end reaching the lower ureter, and was removed via ureteroscopy 6 weeks postoperatively. There was no other operation related morbidity.

Conclusions: Laparoscopic Anderson-Hynes pyeloplasty represents an attractive alternative to conventional open pyeloplasty. It is technically challenging but with practice it may be completed in the same time as conventional open pyeloplasty. It offers results approaching those of conventional dismembered pyeloplasty.