Transmesocolic laparoscopic pyeloplasty in children: A standard approach for the left-side repair

• Published in: Journal of pediatric urology Vol. 6; no. 2; pp. 171 - 177
• Main Authors: Sedláček, Josef, Kočvara, Radim, Molčan, Jaroslav, Dítě, Zdeněk, Dvořáček, Jan
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.04.2010
• Subjects: Adolescent; Child; Child, Preschool; Female; Humans; Hydronephrosis; Hydronephrosis - etiology; Infant; Kidney Pelvis - surgery; Laparoscopic pyeloplasty; Laparoscopy - methods; Male; Mesocolon - surgery; Pediatrics; Pelvi–ureteric junction obstruction; Transmesenteric approach; Transmesocolic approach; Ureteral Obstruction - complications; Ureteral Obstruction - surgery; Uretero–pelvic-junction obstruction; Urology; Transmesenteric approach; Uretero–pelvic-junction obstruction; Laparoscopic pyeloplasty; Hydronephrosis; Pelvi–ureteric junction obstruction; Transmesocolic approach
• ISSN: 1477-5131; 1873-4898
• DOI: 10.1016/j.jpurol.2009.06.010

Abstract Objective To compare the transmesocolic approach in the left laparoscopic pyeloplasty with the laterocolic right-side repair in children. Patients and methods Dismembered pyeloplasty was performed in 77 consecutive children aged 1.2–18.2 years. The transmesocolic approach was used in 49 patients with left hydronephrosis (group I) and the conventional laterocolic approach in 28 patients with right hydronephrosis (group II). Three age groups were defined. Results The transmesocolic approach was applicable in 48 of 49 patients (98%); the colic vessels were preserved. The operation time was significantly shorter in the transmesocolic group, also when comparing patients with similar age, incidence of crossing vessels and urinary diversion. A shorter operation time was achieved in children without internal urine diversion. Postoperative complications were encountered in 6.3% of group I and 7.1% of group II without any conversion to open repair or recurrence of obstruction within a 2.5-year follow-up period. Conclusions The transmesocolic approach offers clear anatomy and provides safe access to the dilated left renal pelvis and crossing vessels. The operative time is shorter due to very limited tissue dissection. The medial reflection of the colon is avoided. This approach allows for microsurgical performance of the left-side pyeloplasty in all paediatric age groups.