Laparoscopic pyeloplasty in children: long-term outcome.
OBJECTIVE
To asses the safety and efficacy of laparoscopic pyeloplasty in pediatric patients.


METHODS
Data of pediatric patients under the age of 14 years, who had undergone laparoscopic pyeloplasty from January 2000 to December 2005, were prospectively analyzed. The various parameters recorded were: operative time, blood loss, need for analgesics, intra/postoperative complications, hospital stay and postoperative outcome. Success was defined as either symptomatic improvement and/or better drainage on postoperative isotope renography


RESULTS
There were 53 patients with a mean age of 9.12 years (1-14 years) and a male to female ratio of 4.3:1. Dismembered pyeloplasty was done in 41 patients and Foley Y-V plasty in 12 patients via a transperitoneal approach using 3 ports in 50 children or 4 ports in 3 children. Mean operative time was 181 min (78-369); mean blood loss was 118.01 mL (50-250) with a mean hospital stay of 5.05 days (2-11). Conversion to open surgery was required in 4 (7.54%) patients. Follow-up renograms were available in 49 patients, which showed improvement in drainage in 44 patients and an obstructed pattern in five; of these, two patients had significant deterioration in split function. Two patients among the obstructed group underwent redo pyeloplasty by open technique while the other three elected for a conservative approach. Thus at a mean follow up of 24.58 months (4-45) the overall success rate was 89.75%.


CONCLUSIONS
Laparoscopic pyeloplasty is a safe and effective, minimally invasive procedure in pediatric patients with a good intermediate term success rate and minimal morbidity.
Ansari
Mohd S
MS
Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India. ansarimsa@hotmail.com
Mandhani
Anil
A
Singh
Partipal
P
Srivastava
Aneesh
A
Kumar
Anant
A
Kapoor
Rakesh
R
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000601:surgery*