Transmesocolic pyeloplasty: experience of a single center.
OBJECTIVE
We present our experience with dismembered left-sided pyeloplasty using a transmesocolic technique as a way to reduce operative time and facilitate repair by avoiding colon displacement.


METHODS
Between January 2004 and January 2006, a total of 11 transmesocolic laparoscopic pyeloplasties were performed by the same surgeon at our institution. The mean patient age was 41.6 years (range 14-65 years). Operative records and follow-up were reviewed.


RESULTS
A dismembered Anderson-Hynes pyeloplasty was carried out in nine patients (82%), while a Y-V plasty (9%) and a Fengerplasty (9%) were done in one patient each. Crossing vessels were observed in 8 patients (73%). A ureteral stent was left in all patients. The mean operative time was 88.6 minutes (range 60-125 minutes), and blood loss was minimal. Compared with classic transperitoneal laparoscopic left pyeloplasties, transmesocolic cases showed a significant reduction in operative time (88.6 minutes v 117 minutes; P < 0.05). There were no intraoperative complications or open conversions. The mean hospital stay was 2.1 days (range 2-3 days). Only 1 patient (9%) demonstrated narrowing of the anastomosis, which occurred 12 months after a Fengerplasty.


CONCLUSIONS
The transmesocolic approach to a dilated left pelvis enables a shorter operative time without increasing morbidity. More patients and longer follow-up are necessary to determine its effect on convalescence.
Castillo
Octavio A
OA
Section of Endourology and Laparoscopic Urology, Department of Urology, Clínica Santa Maria, Santiago de Chile, Chile.
Vitagliano
Gonzalo
G
Alvarez
Juan Manuel
JM
Pinto
Ivan
I
Toblli
Jorge
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged