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A modified technique of paraumbilical three-port laparoscopic dismembered pyeloplasty for infants and children

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Abstract

Background

Common causes of complications of laparoscopic pyeloplasty in children include anastomotic stricture, poor drainage due to high ureteropelvic anastomosis, and torsion of ureter. Herewith, we described our modified technique of paraumbilical three-port laparoscopic dismembered pyeloplasty (PTLDP) to minimize these complications.

Patients and methods

Data from 62 patients (age: 1–180 months, median: 12 months) with ureteropelvic junction obstruction (UPJO) who underwent pyeloplasty using our modified technique of PTLDP between February 2014 and September 2014 at our institution were reviewed. The key steps of our modified method involve identifying the lowest point of the renal pelvis and the lateral aspect of the ureter to guarantee a low pelviureteric and correct orientation anastomosis, and using a 4-0 silk for assistant suturing to avoid crushing of the anastomotic tissue.

Results

All surgeries were successfully completed without conversion. Three patients required an accessory port for the anastomosis. All the patients achieved complete clinical or radiologic resolution after the operation. The mean operative time was 103.4 min, and mean estimated blood loss was 14.4 mL. Mean postoperative differential function of affected kidney was 43.0 ± 16.3 % (range 24–100 %), increased from 39.7 ± 18.0 % (range 18–100 %), preoperatively (p < 0.001). The success rate was 100 % at a mean follow-up of 18.3 ± 2.9 (range 13–25) months.

Conclusions

Our modified technique of PTLDP is safe and feasible and to allow high success rate for the treatment of pelviureteric junction obstruction in children.

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Acknowledgments

The authors thank Prof. Long Li, Xu Zhang, and all the colleagues who helped in the preparation of this article.

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    Authors and Affiliations

    1. Department of Urology, Bayi Children’s Hospital Affiliated to The Military General Hospital of Beijing PLA, No. 5 Nan Mencang, Dongcheng District, Beijing, 100700, China

      Hualin Cao, Huixia Zhou, Lifei Ma, Dehong Liu, Tian Tao & Xiaolong Luo

    2. Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/Chinese PLA Medical Academy, Beijing, 100853, China

      Kan Liu

    3. Department of Surgery, Beijing United Family Hospital, No. 2 Jiangtai, Chaoyang District, Beijing, 100015, China

      Wei Cheng

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    1. Hualin Cao
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    2. Huixia Zhou
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    3. Kan Liu
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    4. Lifei Ma
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    5. Dehong Liu
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    6. Tian Tao
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    Correspondence to Huixia Zhou or Wei Cheng.

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    Funding

    This work was funded by the national public welfare industry research projects (No. 201402007).

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    The authors declare that they have no conflict of interest.

    Additional information

    H. Cao, H. Zhou and K. Liu contributed equally to this work.

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    Cao, H., Zhou, H., Liu, K. et al. A modified technique of paraumbilical three-port laparoscopic dismembered pyeloplasty for infants and children. Pediatr Surg Int 32, 1037–1045 (2016). https://doi.org/10.1007/s00383-016-3958-2

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