LAPAROSCOPIC TRANSPERITONEAL ANDERSON-HYNES PYELOPLASTY: TECHNICAL NOTES AND RESULTS AFTER 100 CASES

INTRODUCTION AND OBJECTIVES: The laparoscopic Anderson- Hynes pyeloplasty is the gold standard for the treatment of the pyeloureteral junction obstruction (PUJO). We described the surgical steps of laparoscopic Anderson-Hynes pyeloplasty with transperitoneal approach and anterograde stent placement done using a personal technique. We reported the morphofunctional results after the first 100 cases. METHODS: Between March 2005 and December 2010, 100 patients, 47 males, 53 females (mean age 31, range 15-59) diagnosed with incidental or symptomatic PUJO, underwent transperitoneal laparoscopic Anderson-Hynes pyeloplasty. In 11(11%) cases, a transmesocolic access to the PUJ was adopted. In all patients surgery was performed using 3 to 5 ports, a 12 mm umbilical/ paraumbilical port for Hasson trocar and the remaining were all 5 mm ports. The placement of an anterograde double J ureteral stent was performed using a personal technique after posterior anastomotic wall closure.The anastomosis was done with 5-0 Vicryl sutures. RESULTS: All operations were completed laparoscopically, and no open conversions were needed. The mean operative time was 120 min (range 90-390). For the last 30 cases the operative time was always less than 120 minutes. Overall, 19 patients (19%) had an abnormal blood vessel that required a transposition in 15 (15/19, 79%). 9 patients (9%) had kidney stones associated. The average time for ureteral stenting was 5 min (range 3-22 min), and in 99 cases (99/100, 99%) it was correctly positioned. The average postoperative hospitalization stay was 4 days (range 3-10). 4 postoperative complications occurred (4%): two patients required prolonged surgical drainage, one had broncopneumonia, one had intrahepatic bleeding of an subcapsular hemangioma, treated conservatively without blood transfusion needing. At a mean follow-up of 36 months (range 1-72) we showed a 97% success rate, documented as a morphofunctional improvement, with absence or reduction of hydronephrosis in asymptomatic patients. A persistent PUJO was detected in three patients and was treated by conservative endoscopic management or by performing an open/laparoscopic pyeloplasty. CONCLUSIONS: Our data confirm the antegrade procedure to be an easy-to-learn and safe. it obviates the problem of having the stent in the renal pelvis during dissection and suturing and of repositioning the patient onto the flank for the laparoscopic procedure. Our study confirms the effectiveness of the laparoscopic technique, in terms of morphofunctional and clinical symptoms resolution, with a high overall success rate (97%).