A single institute's experience in retroperitoneal laparoscopic dismembered pyeloplasty: results with 86 consecutive patients

Abstract

Purpose: To report our institute's retroperitoneal technique of laparoscopic pyeloplasty (LP) and present results of 86 consecutive patients.

Patients and methods: From January 2004 to January 2009, 86 patients who were affected with ureteropelvic junction obstruction (UPJO) underwent retroperitoneal LP. In all operations, a four-port, balloon-dissecting, retroperitoneal approach was used and a simple "personalized" modification of the conventional Anderson-Hynes technique consisting of an approaching and stabilizing stitch made between the renal pelvis and proximal ureter. A needle introductor at the level of the surgical assistant's trocar was used as well to facilitate the Double-J stent introduction. Follow-up studies were performed postoperatively with intravenous urography and renal ultrasonography at 6, 12, and 18 months.

Results: All operations were completed laparoscopically, and no open conversions were needed. The mean operative time was 79.3 minutes (range 65-125 min). The mean blood loss was 10 mL (range 5-40 mL), and the mean postoperative hospitalization stay was 5.7 days (range 3-14 d). No intraoperative complications occurred. Aberrant crossing vessel and primary stricture as the cause of UPJO were noted in 31 and 55 patients, respectively. Transient anastomotic leakage occurred in six patients and was successfully treated by conservative management. A persistent UPJO was detected at first follow-up visit in three patients and was treated by conservative management in two cases and by performing an open pyeloplasty in one case. A mean follow-up of 29 months (range 18 to 48 mos) was performed and showed a 96.6% success rate after the first operation.

Conclusions: Our experience with LP in accordance with the Anderson-Hynes procedure has demonstrated that this technique is an effective treatment for UPJO, with a high overall success rate, a short hospital stay, and a negligible incidence of early complications.