Complications of laparoscopic pyeloplasty in children.
BACKGROUND
Laparoscopic pyeloplasty in children has been proven to be safe and effective, with comparable results to open surgery. Due to the extension of laparoscopic indications from ablative to reconstructive procedures requiring endoscopic suturing, most centres have plateaued within their learning curve. Based on our own experience with a little more than 100 cases, we focus on the complications and the definitive learning curve of laparoscopic pyeloplasty in children.


METHODS
A total of 103 laparoscopic pyeloplasties were performed during the period January 2002 to June 2008. Of these, 102 underwent laparoscopic dismembered pyeloplasty and one underwent laparoscopic vascular hitch for crossing lower pole vessels. Intraoperative incidents/complications were analysed using the Satava classification, and the postoperative complications according to the Clavien classification.


RESULTS
Intraoperative incidents occurred in 2.91% of the cases, mostly without consequences for the child including faulty port placement needing placement of an extra port and umbilical port side bleed. Postoperative complications occurred in 11.65% children and included prolonged ileus, prolonged urinary leak, fever, haematuria and recurrent ureteropelvic junction (UPJ) stenosis. Recurrent UPJ stenosis occurred in 4.85% of children needing reoperation.


CONCLUSIONS
Laparoscopic pyeloplasty in children is not only feasible, but safe and effective. Intraoperative incidents occur in up to 3% of the cases, and complications in 12.9-15.8%. Increased experience, training and knowledge regarding the incidence and management of complications will be able to further reduce these in the future.
Nerli
Rajendra B
RB
Department of Urology, Kles Kidney Foundation, Kles Hospital, Belgaum, India. rajendranerli@yahoo.in
Reddy
Mallikarjun
M
Prabha
Vikram
V
Koura
Ashish
A
Patne
Praveen
P
Ganesh
M K
MK
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007223:Infant; D010535:Laparoscopy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology*; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012086:Reoperation; D012189:Retrospective Studies; D014513:Ureter / Q000601:surgery*; D014517:Ureteral Obstruction / Q000000981:diagnostic imaging / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000009:adverse effects*