Laparoscopic Dismembered Pyeloplasty: Our Experience in 15 Cases
World Journal of Laparoscopic Surgery with DVD
Objectives: To assess the feasibility and effectiveness of transperitoneal laparoscopic pyeloplasty in the treatment of ureteropelvic junction obstruction. Laparoscopic pyeloplasty has been shown to have a success rate comparable to that of the open surgical approach. We report the results of our first 15 cases of transperitoneal dismembered pyeloplasty. Patients and methods: From August 2006 to September 2007, 15 patients underwent laparoscopic transperitoneal pyeloplasty for ureteropelvic
... r ureteropelvic junction obstruction. All patients underwent dismembered pyeloplasty. All patients were followed with diuretic renography (DTPA renal scan) at 3 months and 1year of follow-up and intravenous urography at 1 year follow-up to assess the success of the surgery. Results: Fourteen of the fifteen procedures were successfully completed. The procedure was converted to open surgery in one patient who had history of recurrent UTI and friable tissues which were not holding the sutures. Crossing vessels were identified in 7 out of 15 patients(46.7%) which required transposition of the ureter and pelvis before anastomosis. Four patients had associated calculus disease and in 3 out of 4 patients the calculus was removed. Average operating time was 3.75 hours (range 3 to 5 hours) and the mean blood loss was 150 ml. Mean hospital stay was 5.5 days. Mean duration of analgesic use was 5.2 days. Postoperative complications included urinary peritonitis in one patient and suture granuloma in 2 patients. 14 out of 15 patients(93.33%) showed definite improvement in renal function and drainage on radiographic evaluation. Conclusions: Laparoscopic pyeloplasty (LP) is a safe and effective minimally invasive treatment option that duplicates the principles and techniques of definitive open surgical repair.The success rates associated with LP are comparable to those of the gold standard, open pyeloplasty.