Objective: The aim of this study was to evaluate the long-term functional outcomes of laparoscopic pyeloplasty (LP) in children for consecutive cases of single institute. Materials and Methods: Our laparoscopy database was investigated for children in terms of LP between June 2008 and April 2015. All the patients had ureteropelvic junction obstruction (UPJO) and LP was performed. Demographic data including age, gender, side of UPJO, operation time, estimated blood loss (EBL), hospital stay and complications according to Clavien classifications were recorded. Renal ultrasonography and diethylenetriamine penta-acetate (DTPA) scintigraphies were respectively performed 3, 12 and 24 months after surgery. Statistical analyses were performed and p value was accepted as significant at <0.05. Result: Mean follow-up was 34 ± 4.7 months. The mean age was 13 (6-72) months. A total of 153 (110 boys and 43 girls) LP patients enrolled. Of that, 93 (60.78%) LP were in left side and 60 (39.21%) were in right side. Three cases needed open conversation according to difficulties in anastomosis. Aberrant crossing vessel was observed in 12 (7.84%) patients. The mean operation time was 155 ± 21 min and the mean EBL was 22 ± 11.1 ml. The mean hospital stay was 3.4 days. Anastomotic leakage was the common complication (in 13 patients) that was successfully managed conservatively (Clavien 1). Eight patients experienced unsuccessful LP and underwent open pyeloplasty (Clavien 3b). The mean split renal function significantly increased in DTPA scintigraphy in follow-up. The overall success was 91%. Conclusions: The LP procedure can be an effective and safe surgical method for childhood UPJO, specifically in the experienced hands of pioneer centers.

Keywords:
Laparoscopy, Pyeloplasty, Ureteropelvic junction
1.
Peters CA, Schlussel RN, Retik AB: Pediatric laparoscopic dismembered pyeloplasty. J Urol 1995;153:1962-1965.
2.
Braga LH, Lorenzo AJ, Bägli DJ, et al: Comparison of flank, dorsal lumbotomy and laparoscopic approaches for dismembered pyeloplasty in children older than 3 years with ureteropelvic junction obstruction. J Urol 2010;183:306-311.
3.
Penn HA, Gatti JM, Hoestje SM, et al: Laparoscopic versus open pyeloplasty in children: preliminary report of a prospective randomized trial. J Urol 2010;184:690-695.
4.
Mei H, Pu J, Yang C, et al: Laparoscopic versus open pyeloplasty for ureteropelvic junction obstruction in children: a systematic review and meta-analysis. J Endourol 2011;25:727-736.
5.
Moon DA, El-Shazly MA, Chang CM, Gianduzzo TR, Eden CG: Laparoscopic pyeloplasty: evolution of a new gold standard. Urology 2006;67:932-936.
6.
Fuchs J, Luithle T, Warmann SW, et al: Laparoscopic surgery on upper urinary tract in children younger than 1 year: technical aspects and functional outcome. J Urol 2009;182:1561-1568.
7.
Porpiglia F, Billia M, Volpe A, et al: Transperitoneal left laparoscopic pyeloplasty with transmesocolic access to the pelvi-ureteric junction: technique description and results with a minimum follow-up of 1 year. BJU Int 2008;101:1024-1028.
8.
Singh O, Gupta SS, Hastir A, et al: Laparoscopic dismembered pyeloplasty for ureteropelvic junction obstruction: experience with 142 cases in a high-volume center. J Endourol 2010;24:1431-1434.
9.
Sweeney DD, Ost MC, Schneck FX, et al: Laparoscopic pyeloplasty for ureteropelvic junction obstruction in children. J Laparoendosc Adv Surg Tech A 2011;21:261-265.
10.
Martina GR, Verze P, Giummelli P, et al: A single institute's experience in retroperitoneal laparoscopic dismembered pyeloplasty: results with 86 consecutive patients. J Endourol 2011;25:999-1003.
11.
Nasir AA, Abraham MK, Sudarshan B, et al: Laparoscopic pyeloplasty for children with pelvic ureteric junction obstruction: an institutional experience. Niger Postgrad Med J 2014;21:46-50.
12.
Fernbach SK, Maizels M, Conway JJ: Ultrasound grading of hydronephrosis: introduction to the system used by the society for fetal urology. Pediatr Radiol 1993;23:478-480.
13.
Helmy TE, Harraz A, Sharaf DE, et al: Can renal ultrasonography predict early success after pyeloplasty in children? A prospective study. Urol Int 2014;93:406-410.
14.
Harraz AM, Taha DE, Shalaby I, Hafez AT: Evaluation of factors predicting recoverability of renal function after pyeloplasty in adults. Urol Int 2014;93:403-405.
15.
Nakada SY, Johnson M: Ureteropelvic junction obstruction. Retrograde endopyelotomy. Urol Clin North Am 2000;27:677-684.
16.
Gerber GS, Kim JC: Ureteroscopic endopyelotomy in the treatment of patients with ureteropelvic junction obstruction. Urology 2000;55:198-202.
17.
Schuessler WW, Grune MT, Tecuanhuey LV, et al: Laparoscopic dismembered pyeloplasty. J Urol 1993;150:1795-1799.
18.
Yanke BV, Lallas CD, Pagnani C, et al: The minimally invasive treatment of ureteropelvic junction obstruction: a review of our experience during the last decade. J Urol 2008;180:1397-1402.
19.
Tan HJ, Ye Z, Roberts WW, Wolf JS: Failure after laparoscopic pyeloplasty: prevention and management. J Endourol 2011;25:1457-1462.
20.
Madi R, Roberts WW, Wolf JS Jr: Late failures after laparoscopic pyeloplasty. Urology 2008;71:677-680.
21.
Varkarakis IM, Bhayani SB, Allaf ME, et al: Management of secondary ureteropelvic junction obstruction after failed primary laparoscopic pyeloplasty. J Urol 2004;172:180-182.
22.
Szavay PO, Luithle T, Seitz G, et al: Functional outcome after laparoscopic dismembered pyeloplasty in children. J Pediatr Urol 2010;6:359-363.
23.
Rhodin MM, Anderson BJ, Peters AM, et al: Human renal function maturation: a quantitative description using weight and postmenstrual age. Pediatr Nephrol 2009;24:67-76.
24.
Mandhani A, Kumar D, Kumar A, et al: Steps to reduce operative time in laparoscopic dismembered pyeloplasty for moderate to large renal pelvis. Urology 2005;66:981-984.
25.
Inagaki T, Rha KH, Ong AM, et al: Laparoscopic pyeloplasty: current status. BJU Int 2005;95(suppl 2):102-105.
26.
Türk IA, Davis JW, Winkelmann B: Laparoscopic dismembered pyeloplasty - the method of choice in the presence of an enlarged renal pelvis and crossing vessels. Eur Urol 2002;42:268-275.
27.
Rassweiler JJ, Teber D, Frede T: Complications of laparoscopic pyeloplasty. World J Urol 2008;26:539-547.
28.
Kim SO, Yu HS, Hwang IS, Hwang EC, Kang TW, Kwon D: Early pyeloplasty for recovery of parenchymal thickness in children with unilateral ureteropelvic junction obstruction. Urol Int 2014;92:473-476.
29.
Halachmi S, El-Ghoneimi A, Bissonnette B, et al: Hemodynamic and respiratory effect of pediatric urological laparoscopic surgery: a retrospective study. J Urol 2003;170(4 pt 2):1651-1654.
30.
Neheman A, Noh PH, Brenn R, et al: Laparoscopic urinary tract surgery in infants weighing 6 kg or less: perioperative considerations and comparison to open surgery. J Urol 2008;179:1534-1538.
31.
Sedláček J, Kočvara R, Molčan J, Dítě Z, et al: Transmesocolic laparoscopic pyeloplasty in children: a standard approach for the left-side repair. J Pediatr Urol 2010;6:171-177.
32.
Schneider A, Ferreira CG, Delay C, et al: Lower pole vessels in children with pelviureteric junction obstruction: laparoscopic vascular hitch or dismembered pyeloplasty? J Pediatr Urol 2013;9:419-423.
© 2016 S. Karger AG, Basel
2016
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.