Page 12 - World Journal of Laparoscopic Surgery

Piyush Singhania et al
All patients in our series had primary PUJ obstruction. CONCLUSION
Laparoscopic pyeloplasty has been used even in patients in LP is a safe and effective minimally invasive treatment option
whom previous endoscopic and/or open pyeloplasty had failed. that duplicates the principles and techniques of definitive open
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Sundaram CP et al reported an overall success rate of 94% in surgical repair.The success rates associated with LP are
a series of 36 patients with secondary PUJO. Siqueria et al 18 comparable to those of the gold standard, open pyeloplasty.
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also reported success in 8 of 9 patients. Jarrett reported 17 Laparoscopic pyeloplasty is associated with significant
laparoscopic pyeloplasties with secondary PUJO, with a success reductions in overall morbidity, including less discomfort,
rate of 88%. Notable point recorded in these studies was the shorter hospital stay, lower complication rate, and shorter time
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longer mean operative time. Soulie et al and Lachkar et al 17 to convalescence and is cosmetically superior to the open
report that any previous retroperitoneoscopic procedure makes pyeloplasty.Varied surgical anatomy associated with PUJ like
a new retroperitoneoscopic pyeloplasty unlikely. So a trans- the crossing vessels and high insertion of the ureter in the
peritoneal approach is preferred for such cases over the retro- pelvis can be successfully repaired with laparoscopic
peritoneal approach. pyeloplasty which have been shown to compromise the results
We used transperitoneal approach in all our patients. This of other endourological procedures. The disadvantages include
approach offers more working space and a better field of view the longer operative duration as compared to open pyeloplasty,
which is important for a reconstructive surgery. However , steep learning curve and requires technical expertise. With the
several disadvantages have been reported for this approach. steady increase in worldwide laparoscopic experience and
For access to the retroperitoneum the colon has to be mobilized education, LP is indeed emerging as the new gold standard of
and separated from the Gerota’s fascia. In addition the renal care for symptomatic UPJ obstruction.
pelvis is not completely exposed as the renal artery and vein
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