title: Laparoscopic modified bypass pyeloplasty: a simple procedure for straightforward ureteral spatulation and intracorporeal suturing.
abstract: OBJECTIVE
  Bypass pyeloplasty (BP) is a simple, non-dismembered procedure that is a side-to-side anastomosis without dividing the ureteropelvic junction (UPJ). BP has been considered more suitable especially for novice surgeons than dismembered pyeloplasty via the laparoscopic approach, but not reported. However, the disadvantage of laparoscopic BP is that it is difficult to suture the side of the anastomosis that is far from the camera. To overcome this disadvantage, a modified technique was developed. This procedure and its initial results are reported.
  
  
  METHODS
  Twenty-six consecutive patients underwent laparoscopic modified BP. The patients' median age at surgery was 10.5 years. Ten patients were adults and 16 were children. The key step of modified BP involves dividing the UPJ after ureteral spatulation and suture of the dependent portion. This provides both better visualization of the anastomosis portion and easy anastomosis.
  
  
  RESULTS
  All procedures were completed by laparoscopic modified BP. The median operative time was 246 (range 170-357) min. The median time for ureteropelvic anastomosis was 205 (range 145-311) min. There were no significant differences in mean operative time and ureteropelvic anastomotic time between adults and children (adults/children = 243 ± 49 min:252 ± 58 min, p = 0.66, 192 ± 33 min:214 ± 48 min, p = 0.21, respectively). Successful resolution of UPJO was observed in 96 % of cases.
  
  
  CONCLUSIONS
  Laparoscopic modified BP combines the advantages of non-dismembered and dismembered pyeloplasty. Because there were no differences in mean operative and anastomotic times between adults and children, laparoscopic modified BP might be an efficient procedure for all ages, especially children.
authors.affiliation: Department of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan. pessoco@fmu.ac.jp.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Haga
authors.affiliation: Department of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Sato
authors.affiliation: Department of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
authors.forename: Soichiro
authors.initials: S
authors.lastname: Ogawa
authors.affiliation: Department of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
authors.forename: Michihiro
authors.initials: M
authors.lastname: Yabe
authors.affiliation: Department of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Akaihata
authors.affiliation: Department of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
authors.forename: Junya
authors.initials: J
authors.lastname: Hata
authors.affiliation: Department of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Ishibashi
authors.affiliation: Department of Nephro-urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Mizuno
authors.affiliation: Department of Nephro-urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan.
authors.forename: Yutaro
authors.initials: Y
authors.lastname: Hayashi
authors.affiliation: Department of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Kojima
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D061646:Operative Time; D013536:Suture Techniques; D014513:Ureter / Q000601:surgery*; D014517:Ureteral Obstruction / Q000601:surgery*; D055815:Young Adult
keywords: Children; Laparoscopy; Pyeloplasty; Ureteropelvic junction obstruction; Urology