Page 8 - World Journal of Laparoscopic Surgery

World Journal of Laparoscopic Surgery, May-August 2009;2(2):6-11
Piyush Singhania et al

Laparoscopic Dismembered Pyeloplasty: Our

Experience in 15 Cases

1 2 3
Piyush Singhania, Mukund G Andankar, Hemant R Pathak
1 Senior Resident, Department of Urology, BYL Nair Hospital, Flat No. 203, CitiHill View Apartments, Plot No. 13, Sector 19
Nerul, Navi Mumbai, Mumbai, Maharashtra, India
2 Associate Professor, Department of Urology, BYL Nair Hospital, Room No. 207, 2nd Floor, College Building
Mumbai Central, Mumbai, Maharashtra, India
3 Professor and Head, Department of Urology, BYL Nair Hospital, Room No. 207, 2nd Floor, College Building
Mumbai Central, Mumbai, Maharashtra, India
Correspondence: Piyush Singhania, Senior Resident, Department of Urology, BYL Nair Hospital, Flat No. 203, CitiHill View
Apartments, Plot No. 13, Sector 19, Nerul, Navi Mumbai, Mumbai, Maharashtra, India, Phone: 9324964818
E-mail: piyushsnghn@yahoo.co.in

Abstract INTRODUCTION
Objectives: To assess the feasibility and effectiveness of Surgical management of PUJ obstruction has recently been
transperitoneal laparoscopic pyeloplasty in the treatment of revolutionized by the introduction and widespread adoption of
ureteropelvic junction obstruction. Laparoscopic pyeloplasty has been minimally invasive techniques as alternative to standard open
shown to have a success rate comparable to that of the open surgical reconstructive procedures in an effort to reduce the morbidity
approach. We report the results of our first 15 cases of transperitoneal
dismembered pyeloplasty. of the treatment. Initially, minimally invasive approaches
included antegrade and retrograde endoscopic endopyelotomy.
Patients and methods: From August 2006 to September 2007, 15 Although these procedures are associated with relatively few
patients underwent laparoscopic transperitoneal pyeloplasty for
ureteropelvic junction obstruction. All patients underwent dismembered complications, brief hospitalization and little disability, the
pyeloplasty. All patients were followed with diuretic renography (DTPA reported success rates are low (71 to 88%) as compared to an
renal scan) at 3 months and 1year of follow-up and intravenous open approach. Also these procedures have an increased risk
urography at 1 year follow-up to assess the success of the surgery. of hemorrhage (0 to 12%). 1
Results: Fourteen of the fifteen procedures were successfully Traditional therapy of the obstructed ureteropelvic junction
completed. The procedure was converted to open surgery in one has been open reconstructive surgery (pyeloplasty). The long
patient who had history of recurrent UTI and friable tissues which term success rate of open pyeloplasty has been reported to be
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were not holding the sutures. Crossing vessels were identified in 7 out greater than 90% in adults and children. Despite the high
of 15 patients(46.7%) which required transposition of the ureter and success rate, open pyeloplasty has the disadvantage of a loin
pelvis before anastomosis. Four patients had associated calculus wound and consequent increased morbidity and long
disease and in 3 out of 4 patients the calculus was removed. Average convalescence. Laparoscopic pyeloplasty was originally
operating time was 3.75 hours (range 3 to 5 hours) and the mean developed in an attempt to duplicate the results of open
blood loss was 150 ml. Mean hospital stay was 5.5 days. Mean duration
of analgesic use was 5.2 days. Postoperative complications included pyeloplasty while simultaneously decreasing postoperative
urinary peritonitis in one patient and suture granuloma in 2 patients. 14 morbidity. Laparoscopic pyeloplasty was first described in 1993
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out of 15 patients(93.33%) showed definite improvement in renal by Schuessler et al; since then several groups have reported
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function and drainage on radiographic evaluation. its successful use. Although associated with greater technical
Conclusion: Laparoscopic pyeloplasty (LP) is a safe and effective complexity and a steeper learning curve, in the hands of the
minimally invasive treatment option that duplicates the principles and experienced laparoscopic surgeons, it has been shown to
techniques of definitive open surgical repair.The success rates provide lower patient morbidity, shorter hospitalization and
associated with LP are comparable to those of the gold standard, faster convalescence with the reported success rate matching
open pyeloplasty. those of open pyeloplasty (90% or higher).
Keywords: Laparoscopic pyeloplasty, transperitoneal pyeloplasty, In this study, we present our initial experience with
retroperitoneoscopic pyeloplasty. laparoscopic pyeloplasty by transperitoneal approach,including

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