title: [Laparoscopic transposition of lower polar vessels for pyelo-ureteral junction obstruction: preliminary experience].
abstract: OBJECTIVE
  Lower pole vessels are a classical cause of PUJO even in children. The "gold standard" in the management of PUJ obstructions remains a dismembered pyeloplasty as described by Anderson and Hynes. However, some authors have developed an alternative procedure to this approach with encouraging results. The aim of our study was to evaluate our preliminary results concerning laparoscopic vascular hitch for crossing vessels.
  
  
  METHODS
  We conducted a retrospective, monocentric study of all patients managed by this technique from January 2010 to December 2012.
  
  
  RESULTS
  Eleven patients (7 boys, 4 girls) were managed by laparoscopy at a mean age of 10.7 years (5.4-17). They were referred to our center for clinical symptoms (intermittent pain 7, high blood pressure 1, UTI 1), antenatal diagnosis or accidental discovery. Obstruction was confirmed by MAG3 nephrogram and the presence of obstructive vessels by tomodensitometry or MRI. Mean operative time was 90.2minutes (48-184). Seven patients over 11 were strictly managed by laparoscopic transposition of lower pole vessels. Four required a classical video-assisted dismembered pyeloplasty due to a potential intraluminal stenosis. The latter were suspected by a distension test with furosemid in all four cases. Mean follow-up was 12.9±3 months. Nine patients over 11 were totally non symptomatic, whereas 2 still present mild intermittent pain. In all cases, ultrasound scans show an improvement of the pelvic dilatation.
  
  
  CONCLUSIONS
  Laparoscopic transposition of lower pole vessels is a suitable and feasible alternative for the management of obstructive PUJ. Our preliminary experience emphasizes the need for a precise preoperative selection of patients along with a per operative evaluation of the obstruction. Further experience seems required to improve our criteria in this indication.
  
  
  METHODS
  5.
authors.affiliation: Service de chirurgie pédiatrique, hôpital des enfants de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France. Electronic address: abbo.o@chu-toulouse.fr.
authors.forename: O
authors.initials: O
authors.lastname: Abbo
authors.affiliation: Service de chirurgie pédiatrique, hôpital des enfants de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France.
authors.forename: P-M
authors.initials: PM
authors.lastname: Patard
authors.affiliation: Service de chirurgie pédiatrique, hôpital des enfants de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France.
authors.forename: S
authors.initials: S
authors.lastname: Mouttalib
authors.affiliation: Service de chirurgie pédiatrique, hôpital des enfants de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France.
authors.forename: O
authors.initials: O
authors.lastname: Bouali
authors.affiliation: Service de radiologie pédiatrique, hôpital des enfants de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France.
authors.forename: J
authors.initials: J
authors.lastname: Vial
authors.affiliation: Service de néphrologie pédiatrique, hôpital des enfants de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France.
authors.forename: A
authors.initials: A
authors.lastname: Garnier
authors.affiliation: Service de chirurgie pédiatrique, hôpital des enfants de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France.
authors.forename: P
authors.initials: P
authors.lastname: Galinier
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000151:congenital* / Q000601:surgery; D007668:Kidney / Q000098:blood supply; D010535:Laparoscopy; D008297:Male; D021782:Multicystic Dysplastic Kidney / Q000601:surgery*; D012189:Retrospective Studies; D014517:Ureteral Obstruction / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods; D014656:Vascular Surgical Procedures
keywords: Children; Enfants; Jonction pyélo-urétérale; Laparoscopie; Laparoscopy; Obstruction; Pyelo-ureteral junction