title: Laparoscopic pyeloplasty in children with horseshoe kidney.
abstract: OBJECTIVE
  Laparoscopic pyeloplasty for ureteropelvic junction obstruction associated with horseshoe kidney has been described in adults but seldom in young children. We describe our experience in 10 children treated successfully with laparoscopic dismembered pyeloplasty.
  
  
  METHODS
  Eight boys and 2 girls with a mean age of 8 years (range 0.7 to 16.5) underwent laparoscopic dismembered pyeloplasty for ureteropelvic junction obstruction associated with horseshoe kidney between 2002 and 2012. Presenting symptoms were abdominal pain (3 patients), urinary tract infection (2), abdominal mass (1) and hematuria (1). Horseshoe kidney was diagnosed preoperatively in all cases but 1. The anastomosis was done by running or interrupted 5-zero or 6-zero resorbable sutures and drained by a Double-J® stent.
  
  
  RESULTS
  Laparoscopic dismembered pyeloplasty was feasible in all cases. Mean operating time was 220 minutes (range 180 to 260). Anatomical abnormalities included anteriorly crossing vessels at the ureteropelvic junction in 6 cases (polar vessels in 4, ureteropelvic junction posterior to an abnormal branch of vena cava in 1 and renal vein in 1) and high ureteral insertion in 4. Two children underwent an extensive reduction pyeloplasty. Mean hospital stay was 3.2 days (range 1 to 8). Mean followup was 50 months (range 4 to 132). All patients were asymptomatic with significant improvement of dilatation.
  
  
  CONCLUSIONS
  The transperitoneal laparoscopic approach is adapted for pyeloplasty in children with horseshoe kidney. This procedure allows global exploration of the upper tract and efficient identification of anatomical anomalies, especially crossing vessels. Although our series is small, it is the first known description specific to horseshoe kidney in children and demonstrates that this approach has lasting effectiveness in young children.
authors.affiliation: Department of Pediatric Surgery and Urology, Robert Debré University Hospital, AP-HP Université Paris Diderot, Sorbonne Paris Cité, Paris and Department of Pediatric Surgery, Centre Hospitalier Saint Denis, Saint-Denis (EK), France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Blanc
authors.affiliation: Department of Pediatric Surgery and Urology, Robert Debré University Hospital, AP-HP Université Paris Diderot, Sorbonne Paris Cité, Paris and Department of Pediatric Surgery, Centre Hospitalier Saint Denis, Saint-Denis (EK), France.
authors.forename: Efstathia
authors.initials: E
authors.lastname: Koulouris
authors.affiliation: Department of Pediatric Surgery and Urology, Robert Debré University Hospital, AP-HP Université Paris Diderot, Sorbonne Paris Cité, Paris and Department of Pediatric Surgery, Centre Hospitalier Saint Denis, Saint-Denis (EK), France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Botto
authors.affiliation: Department of Pediatric Surgery and Urology, Robert Debré University Hospital, AP-HP Université Paris Diderot, Sorbonne Paris Cité, Paris and Department of Pediatric Surgery, Centre Hospitalier Saint Denis, Saint-Denis (EK), France.
authors.forename: Annabel
authors.initials: A
authors.lastname: Paye-Jaouen
authors.affiliation: Department of Pediatric Surgery and Urology, Robert Debré University Hospital, AP-HP Université Paris Diderot, Sorbonne Paris Cité, Paris and Department of Pediatric Surgery, Centre Hospitalier Saint Denis, Saint-Denis (EK), France. Electronic address: alaa.elghoneimi@rdb.aphp.fr.
authors.forename: Alaa
authors.initials: A
authors.lastname: El-Ghoneimi
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007668:Kidney / Q000002:abnormalities*; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D012189:Retrospective Studies; D014517:Ureteral Obstruction / Q000150:complications* / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods
keywords: child; kidney diseases; kidney pelvis; laparoscopy; urologic surgical procedures