Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction Following Open Pyeloplasty in Children

Objective: Few studies have evaluated the role of laparoscopic dismembered pyeloplasty in the setting of recurrent ureteropelvic junction (UPJ) obstruction following open dismembered pyeloplasty in the pediatric population. We present our experience at a single institution. Patients and Methods: A retrospective analysis was performed of patients treated with laparoscopic pyeloplasty for secondary UPJ obstruction from March 2003 to August 2011 at a single institution. These patients were age and temporally matched with a control group of patients undergoing primary laparoscopic pyeloplasty. Results: In total, 5 patients were identified as having undergone laparoscopic pyeloplasty for secondary UPJ obstruction following open dismembered pyeloplasty. Operative time was longer in the secondary repair group compared with the control group (190 versus 141 minutes; P=.24), although this was complicated by 1 patient in the secondary repair group undergoing multiple procedures. Morphine equivalent use and length of stay were similar (4.1 versus 6.6mg [P=.21] and 1.4 versus 1.2 days [P=.67] in control patients versus secondary repair patients, respectively). All of the 5 (100%) patients undergoing secondary repair had successful outcomes with improved hydronephrosis on ultrasound, and 4 of 4 (100%) had improved or normal T1/2 times on postoperative mercaptoacetyltriglycine (MAG3) renal scan. One family in each group declined the renal scan for personal reasons. No complications were noted with a mean follow-up time of 13 months in both groups. Conclusions: Laparoscopic repair of secondary UPJ obstruction is a well-tolerated and effective option. When this technique is compared with primary laparoscopic pyeloplasty, results appear equivalent even after failed open repair, with comparable postoperative narcotic requirement and length of stay. Further studies are needed to better define the role of secondary laparoscopic pyeloplasty in the pediatric population, especially with regard to cost compared with other open and minimally invasive techniques.