Transmesenteric laparoscopic pyeloplasty.
OBJECTIVE
Traditionally transperitoneal laparoscopic access to ureteropelvic junction obstruction has been performed in retrocolic fashion. We assessed transmesenteric laparoscopic pyeloplasty to correct ureteropelvic junction obstruction and compared results to those in patients undergoing traditional retrocolic laparoscopic pyeloplasty.


METHODS
Between August 1999 and July 2005, 188 consecutive transperitoneal laparoscopic pyeloplasties were performed at our institution. A total of 18 patients underwent a transmesenteric approach and 170 underwent the classic retrocolic approach. Patient selection for the transmesenteric approach was at surgeon discretion with the inclusion criterion of recognition of the renal pelvis and/or ureter through the descending colonic mesentery.


RESULTS
Compared to patients undergoing traditional retrocolic procedure the transmesenteric approach was more commonly applied in younger individuals and males, and for pathological conditions on the left side and malrotated kidneys. The transmesenteric approach lowered operative time by a mean of 22.5% and decreased hospital stay by 19.2%. The patency success rate was 100% at a mean followup of 18.6 months for the transmesenteric approach and 94.1% at a mean followup of 22 months for the retrocolic approach.


CONCLUSIONS
In a select group of patients transmesenteric pyeloplasty may represent a more rapid alternative to the transperitoneal retrocolic approach and speed convalescence with similar success rates.
Romero
Frederico R
FR
The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Wagner
Andrew A
AA
Trapp
Claudemir
C
Permpongkosol
Sompol
S
Muntener
Michael
M
Link
Richard E
RE
Kavoussi
Louis R
LR
D000293:Adolescent; D000328:Adult; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D002648:Child; D005260:Female; D006801:Humans; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008643:Mesentery / Q000601:surgery; D008875:Middle Aged; D012189:Retrospective Studies; D014517:Ureteral Obstruction / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*