title: Laparoscopic transposition of lower pole crossing vessels (vascular hitch) in children with pelviureteric junction obstruction.
abstract: BACKGROUND
  Congenital hydronephrosis due to intrinsic or extrinsic uretero-pelvic-junction (UPJ) obstruction (UPJO) is a common problem in childhood UPJO may be caused by intrinsic disorganization or by extrinsic compression from crossing vessels (CV); extrinsic causes usually present symptomatically in older children. This report the large Italian experience in the treatment of children with extrinsic-UPJO by CV.
  
  
  METHODS
  We analyzed the data of 51 children (17 girls and 34 boys, median age 10, 7 years) affected by extrinsic-UPJO were treated in three Italian institutions with laparoscopic transposition of CV (Hellström Vascular Hitch modified by Chapman).The intraoperative diuretic-test was performed in all patients before and after the vessels transpositions confirming the extrinsic-UPJO. We included in the study only patients with suspicion of vascular extrinsic obstruction of the UPJ. Symptoms at presentation were recurrent abdominal/flank pain and haematuria. All patients presented intermittent ultrasound (US) detection of hydronephrosis (range, 18-100 mm). Preoperative diagnostic studies included: US/doppler scan, MAG3-renogram, functional-magnetic-resonance-urography (fMRU).
  
  
  RESULTS
  Median operative time was 108 minutes; median hospital stay: 3, 4 days. Unique complications: a small abdominal wall hematoma and higher junction-translocation without obstruction. During follow-up (range, 12-96 months) all patients reported resolution of their symptoms, a decrease in the hydronephrosis grade and improved drainage on diuretic renogram.
  
  
  CONCLUSIONS
  We believe that Vascular Hitch is less technically demanding than laparoscopic pyeloplasty, resulting in a lower complication rate and a significantly reduced hospitalization. The results of our study allow us to conclude that laparoscopic VH may be a safe, feasible, and attractive alternative to treat obstructed hydronephrosis due to CV presenting a useful alternative to AHDP in the management of symptomatic children where CV are deemed the sole aetiology. We recommend careful patient selection based on preoperative clinical and radiologic findings that are diagnostic of extrinsic-UPJO, combined with intraoperative-DT to confirm the appropriate selection of corrective procedure.
authors.affiliation: Department of Pediatric Surgery "Federico II" University of Naples School of Medicine, Naples, Italy.
authors.forename: Ciro
authors.initials: C
authors.lastname: Esposito
authors.affiliation: Department of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies, San Bortolo Hospital, Vicenza, Italy.
authors.forename: Cosimo
authors.initials: C
authors.lastname: Bleve
authors.affiliation: Department of Pediatric Surgery "Federico II" University of Naples School of Medicine, Naples, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Escolino
authors.affiliation: Division of Pediatric Urology, Department of Nephrology and Urology "Bambino Gesù" Children's Hospital, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Caione
authors.affiliation: Division of Pediatric Urology, Department of Nephrology and Urology "Bambino Gesù" Children's Hospital, Rome, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Gerocarni Nappo
authors.affiliation: Department of Pediatric Surgery "Federico II" University of Naples School of Medicine, Naples, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Farina
authors.affiliation: Department of Pediatric Surgery "Federico II" University of Naples School of Medicine, Naples, Italy.
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Caprio
authors.affiliation: Department of Pediatric Surgery "Federico II" University of Naples School of Medicine, Naples, Italy.
authors.forename: Mariapina
authors.initials: M
authors.lastname: Cerulo
authors.affiliation: Division of Pediatric Nephrology, Second University of Naples, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: La Manna
authors.affiliation: Department of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies, San Bortolo Hospital, Vicenza, Italy.
authors.forename: Salvatore Fabio
authors.initials: SF
authors.lastname: Chiarenza
keywords: Extrinsic uretero pelvic junction obstruction; laparoscopy; vascular hitch