title: Transperitoneal laparoscopic pyeloplasty in children.
abstract: OBJECTIVE
  Ureteropelvic junction (UPJ) obstruction remains the most common cause of hydronephrosis in newborns and children. Open pyeloplasty has been the gold standard for management of UPJ obstruction in these patients. We report our technique and outcome with laparoscopic transperitoneal dismembered pyeloplasty in children.
  
  
  METHODS
  Nineteen patients, ages 2 to 14 years, underwent laparoscopic pyeloplasty at our center between June 2004 and December 2006. Thirteen pyeloplasties were on the left side and six on the right side. A transmesocolic approach was used in five left-sided UPJ obstructions. All operations were performed by the transperitoneal route using either three or four ports.
  
  
  RESULTS
  Sixteen patients underwent dismembered (Anderson-Hynes) pyeloplasty, while three had a nondismembered Foley's Y-V pyeloplasty. Mean operative time was 198 minutes (range 105-300 min). Mean estimated blood loss was 45 mL (range 30-130 mL). Mean length of stay was 4 days (range 3-5 d). Mean followup was 13.8 months (range 2-30 mos). Postoperatively, one child had a urinary tract infection that necessitated hospital admission and administration of intravenous antibiotics. Eighteen of 19 patients demonstrated improved drainage with no evidence of obstruction on diuretic renography and/or excretory urography. One patient is awaiting follow-up. There was no conversion to open surgery.
  
  
  CONCLUSIONS
  Laparoscopic pyeloplasty in children is a safe, minimally invasive treatment option that duplicates the principles and techniques of definitive open surgical repair. It is technically challenging; with increasing expertise, operative times are reduced significantly.
authors.affiliation: Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India.
authors.forename: Harprit
authors.initials: H
authors.lastname: Singh
authors.forename: Arvind
authors.initials: A
authors.lastname: Ganpule
authors.forename: Vineet
authors.initials: V
authors.lastname: Malhotra
authors.forename: T
authors.initials: T
authors.lastname: Manohar
authors.forename: V
authors.initials: V
authors.lastname: Muthu
authors.forename: Mahesh
authors.initials: M
authors.lastname: Desai
mesh_terms: D000293:Adolescent; D000714:Anastomosis, Surgical; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006869:Hydronephrosis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D007682:Kidney Pelvis / Q000601:surgery*; D008297:Male; D010537:Peritoneum; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014517:Ureteral Obstruction / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*