title: Laparoscopic transabdominal pyeloplasty in children is feasible irrespective of age.
abstract: OBJECTIVE
  We assessed the feasibility of laparoscopic transabdominal dismembered pyeloplasty in 46 infants and children with regard to patient age.
  
  
  METHODS
  A total of 46 consecutive infants and children (31 male and 15 female) underwent laparoscopic transabdominal dismembered pyeloplasty using a 3 to 4-trocar technique. All patients had confirmed unilateral deterioration of renal function on isotope renography. The 46 patients were divided into 3 age groups--1 to 12 months (group 1, 14 patients), 1 to 7 years (group 2, 15 patients) and 7 to 18 years (group 3, 17 patients). Followup included clinical and ultrasound assessment, and isotope renography at 3 months.
  
  
  RESULTS
  Laparoscopic pyeloplasty was feasible in 44 of 46 patients (96%). Mean operative time was 175 minutes (range 120 to 270). The operation was converted due to impracticality of stenting the PUJ in 1 patient, and due to bleeding in 1. Mean operative time in 44 successful laparoscopic procedures was not significantly different among the 3 age groups (171 minutes in group 1, 169 minutes in group 2 and 173 minutes in group 3). Two patients required operative intervention for PUJ leakage, and 1 underwent percutaneous nephrostomy with a further uneventful course. Mean followup was 29 months (range 3 to 86). A total of 44 patients (96%) were asymptomatic and had improved PUJ drainage on isotope renography. Two patients underwent redo pyeloplasty due to recurrent hydronephrosis at 1 month and 2 years.
  
  
  CONCLUSIONS
  Laparoscopic transabdominal dismembered pyeloplasty is effective and safe in infants and children. The feasibility is also excellent in patients younger than 1 year. The transabdominal approach revealed good exposition without a disadvantage for the patient.
authors.affiliation: Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany. metzelm@web.de
authors.forename: M L
authors.initials: ML
authors.lastname: Metzelder
authors.forename: F
authors.initials: F
authors.lastname: Schier
authors.forename: C
authors.initials: C
authors.lastname: Petersen
authors.forename: M
authors.initials: M
authors.lastname: Truss
authors.forename: B M
authors.initials: BM
authors.lastname: Ure
mesh_terms: D000005:Abdomen; D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D014517:Ureteral Obstruction / Q000601:surgery*