1461 JOURNAL OF ENDOUROLOGY Volume 21, Number 12, December 2007 © Mary Ann Liebert, Inc. DOI: 10.1089/end.2007.0023 Transperitoneal Laparoscopic Pyeloplasty in Children HARPRIT SINGH, M.S., ARVIND GANPULE, M.S., DNB, VINEET MALHOTRA, M.S., T. MANOHAR, M.S., DNB, V. MUTHU M.S., MCh, and MAHESH DESAI, M.S., FRCS, FRCS ABSTRACT Background and Purpose: Ureteropelvic junction (UPJ) obstruction remains the most common cause of hy- dronephrosis in newborns and children. Open pyeloplasty has been the gold standard for management of UPJ obstruction in these patients. We report our technique and outcome with laparoscopic transperitoneal dis- membered pyeloplasty in children. Patients and Methods: Nineteen patients, ages 2 to 14 years, underwent laparoscopic pyeloplasty at our cen- ter between June 2004 and December 2006. Thirteen pyeloplasties were on the left side and six on the right side. A transmesocolic approach was used in five left-sided UPJ obstructions. All operations were performed by the transperitoneal route using either three or four ports. Results: Sixteen patients underwent dismembered (Anderson-Hynes) pyeloplasty, while three had a nondis- membered Foley’s Y-V pyeloplasty. Mean operative time was 198 minutes (range 105–300 min). Mean esti- mated blood loss was 45 mL (range 30–130 mL). Mean length of stay was 4 days (range 3–5 d). Mean follow- up was 13.8 months (range 2–30 mos). Postoperatively, one child had a urinary tract infection that necessitated hospital admission and administration of intravenous antibiotics. Eighteen of 19 patients demonstrated im- proved drainage with no evidence of obstruction on diuretic renography and/or excretory urography. One patient is awaiting follow-up. There was no conversion to open surgery. Conclusion: Laparoscopic pyeloplasty in children is a safe, minimally invasive treatment option that du- plicates the principles and techniques of definitive open surgical repair. It is technically challenging; with in- creasing expertise, operative times are reduced significantly. INTRODUCTION U RETEROPELVIC JUNCTION (UPJ) obstruction is the most common cause of hydronephrosis in newborns and children. Open pyeloplasty has been the gold standard for UPJ obstruction in adults and children, with an overall success rate of 90% to 100%. 1–3 Open pyeloplasty has several shortcomings, including significant postoperative pain, prolonged convalescence, and a prominent skin incision. 4,5 Procedures such as antegrade and ret- rograde endopyelotomy, although less invasive, have lower suc- cess rates of 70% to 89% in highly selected patients, 6,7 In 1993, Schuessler and associates 8 first described the dis- membered laparoscopic pyeloplasty in adults. Tan and col- leagues 9 reported the first pediatric series of transperitoneal lap- aroscopic dismembered pyeloplasties. We report our technique and outcome of laparoscopic dismembered pyeloplasty via a transperitoneal approach in children. PATIENTS AND METHODS The diagnosis of UPJ obstruction was established in all pa- tients based on history, physical examination, and radiographic studies. All patients were evaluated preoperatively with ultra- sonography, diuretic renography, and/or excretory urography. Indications for surgery were children with symptoms who had an obstructive pattern seen on a diuretic scan, a repeated urinary tract infection, or antenatal hydronephrosis with in- creasing hydronephrosis or deteriorating renal function on a subsequent renal scan. An informed written consent was obtained before surgery. All patients underwent cystoscopy and retrograde pyelogra- phy to confirm the site and length of the lesion. Placement of a 3F to 5F ureteral or pigtail catheter before pyeloplasty facil- itated identification and dissection of the renal pelvis. Two types of repairs were performed, depending on the an- Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India.