Experience with laparoscopy-assisted retroperitoneal pyeloplasty in children.
OBJECTIVE
To describe a laparoscopy-assisted retroperitoneal pyeloplasty (LARP) and results of initial experience.


METHODS
Port placement used by Farhat in retroperitoneal-assisted laparoscopic pyeloplasty was modified for better cosmetic results. Surgery was done using 2-cm incision for 5-mm camera port and two 3-mm working ports. Dissection was done anterior to the kidney. The ureteropelvic junction was brought out through the 2-cm trocar site and the pyeloplasty was performed extracorporeally. Between January 2004 and February 2008, a total of 39 kidneys in 38 children with mean age of 4.1 months underwent LARP. The operative time, hospital stay, functional outcome and follow-up renogram studies were reviewed.


RESULTS
The mean operative time was 147 min. 2-cm incision was extended in one patient with malrotated kidney. There was improvement in function in 37 (95%) with no failure. The mean split renal function, preoperative and at follow-up were 35.7 and 44.2%, respectively (P = 0.000). The mean glomerular filtration rate (ml/min), preoperative and at follow-up were 27.4 and 39.1%, respectively (P = 0.000). Mean follow-up period was 24 months.


CONCLUSIONS
LARP is safe in treating UPJ obstruction in infants. It is recommended especially in small babies where laparoscopic pyeloplasty is difficult.
Abraham
Mohan K
MK
Department of Pediatric Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Lane, Elamakkara P.O., Kochi, India. mohanabraham@aims.amrita.edu
Nasir
Abdul Rasheed A
AR
Bindu
S
S
Ramakrishnan
P
P
Kedari
Prashant M
PM
Unnithan
Gopidas R
GR
Damisetti
Kalyan Ravi Prasad
KR
D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006869:Hydronephrosis / Q000209:etiology; D007223:Infant; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control; D012187:Retroperitoneal Space / Q000601:surgery; D014513:Ureter / Q000601:surgery*; D014517:Ureteral Obstruction / Q000150:complications / Q000601:surgery*