Introduction : Laparoscopic dismembered pyeloplasty has been quoted to have equivalent success rates to the traditional open procedure. The aim of this study was to report our experience and compare the retroperitoneal and transperitoneal approaches in adults. Method : All patients presenting with UPJO between 1994 and 2004 were entered into a database to record patient, operative and post-operative details. All retroperitoneal and transperitoneal laparoscopic pyeloplasty procedures were analysed and compared to determine whether the approach had any effect on operative success rates. Result : A total of 127 procedures were performed for UPJO at our tertiary referral centre. Of these, 63 were dismembered laparoscopic pyeloplasties and so were included in this analysis. Two patients had bilateral procedures, therefore 61 adults (male 28, female 35) were included. Fifteen underwent retroperitoneal and 48 underwent transperitoneal laparoscopic pyeloplasty. Seven patients had had previous surgery. The retroperitoneal group had a mean follow up of 22 months (range 4-42). Five of these patients (33%) developed recurrent symptoms with evidence of obstruction seen on the renogram within 4 months (mean 3.3) and required further surgery. Within the transperitoneal group, 11 patients had not attended for follow up yet and so were excluded from further analysis. The remaining patients had a mean follow up of 9.5 months (range 2-25). Two patients were classified as failures at 3 months follow up resulting in a success rate of 95% for the transperitoneal route compared with 67% for the retroperitoneal group (p = 0.02). Conclusion : Currently all procedures are performed via the transperitoneal route as the retroperitoneal approach was associated with a lower success rate. There are several potential explanations for this; the first 15 cases were the first pyeloplasties performed, the transperitoneal route is more familiar and none of the anastamoses in the retroperitoneal group were transposed to the other side of any crossing vessels.

OUR EXPERIENCE WITH LAPAROSCOPIC PYELOPLASTY FOR THE TREATMENT OF URETEROPELVIC JUNCTION OBSTRUCTION / K. Davenport; A. Minervini; A. G. Timoney; F. X. Keeley. - In: JOURNAL OF ENDOUROLOGY. - ISSN 0892-7790. - STAMPA. - Abstract 22nd World Congress on Endourology:(2004), pp. 32-32. (Intervento presentato al convegno 22nd World Congress on Endourology tenutosi a Mumbai (India) nel 2-5 Novembre).

OUR EXPERIENCE WITH LAPAROSCOPIC PYELOPLASTY FOR THE TREATMENT OF URETEROPELVIC JUNCTION OBSTRUCTION

MINERVINI, ANDREA;
2004

Abstract

Introduction : Laparoscopic dismembered pyeloplasty has been quoted to have equivalent success rates to the traditional open procedure. The aim of this study was to report our experience and compare the retroperitoneal and transperitoneal approaches in adults. Method : All patients presenting with UPJO between 1994 and 2004 were entered into a database to record patient, operative and post-operative details. All retroperitoneal and transperitoneal laparoscopic pyeloplasty procedures were analysed and compared to determine whether the approach had any effect on operative success rates. Result : A total of 127 procedures were performed for UPJO at our tertiary referral centre. Of these, 63 were dismembered laparoscopic pyeloplasties and so were included in this analysis. Two patients had bilateral procedures, therefore 61 adults (male 28, female 35) were included. Fifteen underwent retroperitoneal and 48 underwent transperitoneal laparoscopic pyeloplasty. Seven patients had had previous surgery. The retroperitoneal group had a mean follow up of 22 months (range 4-42). Five of these patients (33%) developed recurrent symptoms with evidence of obstruction seen on the renogram within 4 months (mean 3.3) and required further surgery. Within the transperitoneal group, 11 patients had not attended for follow up yet and so were excluded from further analysis. The remaining patients had a mean follow up of 9.5 months (range 2-25). Two patients were classified as failures at 3 months follow up resulting in a success rate of 95% for the transperitoneal route compared with 67% for the retroperitoneal group (p = 0.02). Conclusion : Currently all procedures are performed via the transperitoneal route as the retroperitoneal approach was associated with a lower success rate. There are several potential explanations for this; the first 15 cases were the first pyeloplasties performed, the transperitoneal route is more familiar and none of the anastamoses in the retroperitoneal group were transposed to the other side of any crossing vessels.
2004
Journal of Endourology
22nd World Congress on Endourology
Mumbai (India)
K. Davenport; A. Minervini; A. G. Timoney; F. X. Keeley
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