title: Outcomes of Re-Intervention for Laparoscopic Transperitoneal Pyeloplasty in Children.
abstract: BACKGROUND
  There is no consensus for the management of failed laparoscopic pyeloplasty in pediatric surgical patients, and only limited publications are available. We evaluated here the clinical outcomes of re-intervention for failed laparoscopic transperitoneal pyeloplasty in infants and children.
  
  
  METHODS
  Retrospective review of all children who had undergone laparoscopic transperitoneal dismembered Anderson-Hynes pyeloplasty for ureteropelvic junction obstruction from 2002 to 2013 was performed. Patients' demographics, indications, operative details, and outcomes for primary operation as well as re-intervention were studied.
  
  
  RESULTS
  There were 42 patients with a median age of 20 months (range, 3-192 months) and a median body weight of 12 kg (range, 6-56 kg) who underwent a total of 46 laparoscopic transperitoneal pyeloplasties during the study period. The median operative time and blood loss were 193 minutes (range, 115-480 minutes) and trace amount (range, trace amount to 400 mL), respectively. No conversion was reported. Ten cases (22%) required re-intervention. No statistically significant risk factor for failed pyeloplasty was identified. Indications for re-intervention included deterioration of differential renal function (n = 6), progressive hydronephrosis (n = 1), urinary ascites (n = 2), and urosepsis (n = 1). Median time of re-intervention was 6.5 ± 38 months postpyeloplasty. Re-intervention was categorized into the redo pyeloplasty group (n = 6) and the urinary diversion group (n = 4) (insertion of double-J ureteral stent or endopyelotomy) with success rates of 50% and 25%, respectively. Among the redo pyeloplasty group, 3 patients underwent redo laparoscopic pyeloplasty, and all of them had drainage restored with a median improvement in differential renal function of 11%. The mean follow-up duration was 77 ± 38 months.
  
  
  CONCLUSIONS
  Laparoscopic transperitoneal pyeloplasty is safe and feasible in children. Redo pyeloplasty is a more favorable re-intervention compared with urinary diversion in our series. Redo laparoscopic pyeloplasty has been shown to improve differential renal function.
authors.affiliation: Division of Paediatric Surgery, Department of Surgery, The University of Hong Kong , Queen Mary Hospital, Hong Kong .
authors.forename: Ling
authors.initials: L
authors.lastname: Leung
authors.affiliation: Division of Paediatric Surgery, Department of Surgery, The University of Hong Kong , Queen Mary Hospital, Hong Kong .
authors.forename: Ivy Hau Yee
authors.initials: IH
authors.lastname: Chan
authors.affiliation: Division of Paediatric Surgery, Department of Surgery, The University of Hong Kong , Queen Mary Hospital, Hong Kong .
authors.forename: Patrick Ho Yu
authors.initials: PH
authors.lastname: Chung
authors.affiliation: Division of Paediatric Surgery, Department of Surgery, The University of Hong Kong , Queen Mary Hospital, Hong Kong .
authors.forename: Lawrence Chuen Leung
authors.initials: LC
authors.lastname: Lan
authors.affiliation: Division of Paediatric Surgery, Department of Surgery, The University of Hong Kong , Queen Mary Hospital, Hong Kong .
authors.forename: Kenneth Kak Yuen
authors.initials: KK
authors.lastname: Wong
authors.affiliation: Division of Paediatric Surgery, Department of Surgery, The University of Hong Kong , Queen Mary Hospital, Hong Kong .
authors.forename: Paul Kwong Hang
authors.initials: PK
authors.lastname: Tam
mesh_terms: D000293:Adolescent; D016063:Blood Loss, Surgical; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D061646:Operative Time; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014517:Ureteral Obstruction / Q000601:surgery*; D014547:Urinary Diversion