LAUSR

INTRODUCTION AND OBJECTIVE: Limited working space and small ureteral caliber make laparoscopic pyeloplasty in infants challenging. We report our experience and feasibility with pure laparoscopic pyeloplasty in children younger than 12 months old. METHODS: A retrospective analysis was performed on 23 patients who underwent laparoscopic pyeloplasty by a single surgeon from January 2015 to December 2018. Laparoscopic pyeloplasty was performed using the transperitoneal dismembered technique, and intraoperative double J ureteral stent (4.7Fr or 4.8Fr) was inserted in all patients. Surgical factors, complications, and changes of hydronephrosis before and after surgery were analyzed. RESULTS: The mean age of the 23 children was 5.5 (2.2-11.1) months. There were 17 boys and 6 girls. Surgical indications were deterioration of hydronephrosis (15 children), split renal function less than 40% (4), and recurrent urinary tract infection (4). The mean operation time was 127.6 (80-185) minutes. The blood loss was less than 10cc and there were no intraoperative complications. Two patients underwent conservative treatment due to postoperative paralytic ileus. The mean hospital stay after surgery was 2.6 (2-6) days and the ureteral stent was removed after an mean of 31 (22-35) days. The grade 4 of hydronephrosis improved to an mean grade of 2.2 on ultrasound at 6 to 12 months after surgery. The mean AP diameter significantly decreased from 4.3 (1.5-7.2)cm before surgery to 1.4 (0.65-4.0)cm at 6 to 12months after surgery (p<0.001). The mean parenchymal thickness also significantly increased from 2.5 (1.43.9)mm to 6.2 (4.4-9.7)mm (p<0.001). CONCLUSIONS: Laparoscopic pyeloplasty in infants has no technical limitations compared to older children and can be safely applied. Our experience reveals a success rate comparable to that of other treatment modalities with minimal morbidity. When the hydronephrosis is severe, the operation field is wider than the open pyeloplasty, there is an advantage that renal pelvis and ureter can be anastomosed in the exact position.