Retroperitoneal laparoscopic dismembered pyeloplasty with a novel technique of JJ stenting in children

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Laparoscopic dismembered pyeloplasty may be performed via a transperitoneal or retroperitoneal approach. Retroperitoneal access is less popular because of the limited working space, especially in children. This study shows that retroperitoneal laparoscopic dismembered pyeloplasty with a novel technique of JJ stenting is a feasible and effective alternative to open pyeloplasty with a relatively minimal complication rate in children. OBJECTIVE • To report our experience with retroperitoneal laparoscopic dismembered pyeloplasty for pelvi‐ureteric junction (PUJ) obstruction in children. PATIENTS AND METHODS • Between March 2007 and December 2009, 38 children with PUJ obstruction (mean age 8.3 years, range 3–14) underwent retroperitoneal laparoscopic dismembered pyeloplasty. • A ureteric catheter was inserted into the mid‐ureter cystoscopically. During pyeloplasty, the proximal end of the ureteric catheter was extracorporeally sutured to the distal end of the JJ stent with silk. • The ureteric catheter was then pulled down and the stent was pulled antegrade into the ureter and bladder. RESULTS • The approach was retroperitoneal in all patients except one who required open conversion. The overall mean operative time was 162 min (range 145–210 min) and this appeared to decrease with experience. Mean hospital stay was 4 days (range 3–7 days). • Mean follow‐up was 20.2 months (range 6–32 months). Satisfactory drainage with decreased hydronephrosis was documented in all patients on ultrasonography and intravenous urography. CONCLUSION • Our study shows that retroperitoneal laparoscopic dismembered pyeloplasty is a feasible and effective alternative to open pyeloplasty with a relatively minimal complication rate in children 3 years of age and older, but it should be undertaken by experienced laparoscopic surgeons.