Modified retroperitoneal laparoscopic dismembered pyeloplasty for children

Abstract

We describe our modified retroperitoneal laparoscopic pyeloplasty (MRLP) and assess the incidence of anastomotic stricture and torsion of the ureter in the mid-term. We reviewed 12 patients with ureteropelvic junction obstruction (UPJO) we treated with MRLP between 2013 and 2018. MRLP involves: identifying the lowest point of the renal pelvis and the lateral aspect of the ureter to ensure correct orientation of the anastomosis; placing the first suture between the lower edge of the incised pelvis and the distal end of the spatulated ureter to avoid crushing tissue that will be anastomosed; and complete excision of the narrow segment. All MRLP were completed successfully without conversion. UPJO was resolved completely, both clinically and radiologically, in all cases. Mean age at surgery was 6.8 years (range: 1.7–8.8 years); mean operative time was 212.1 min (range: 170–333 min); mean estimated blood loss was 4.2 mL (range: 2–8 mL); mean follow-up was 36.7 months (range: 6–65 months); mean post-operative differential renal function on the affected side was 53.1\u2009±\u200913.7% (range: 37.0–87.2%), increased from 44.9\u2009±\u200916.0% (range: 27.0–84.3%), pre-operatively (p\u2009=\u20090.02). All remain completely cured after mean follow-up of 36.7\u2009±\u200919.7 months (range: 6–65). Our MRLP is safe and effective despite limited retroperitoneal space.