Laparoscopic Pyeloplasty: The First One Hundred Cases
Thomas W. Jarrett, David Y. Chan,
Tanya C. Charambura, Oscar Fugita, Louis R. Kavoussi*
Laparoscopic pyeloplasty was developed as a minimally invasive alternative
to an open procedure in the treatment of uretero-pelvic junction
obstruction (UPJO). Long term follow-up has not yet been reported.
We present the experience with the first one hundred consecutive
cases performed at our institution.
Materials and Methods
A retrospective review of 100 consecutive laparoscopic pyeloplasties
in 99 patients (means age 37.3 years) between Augusts 1993 and January
1999 was performed. All patients had radiographic evidence of obstruction
with signs, symptoms or deterioration of renal function. Repair
was for a primary UPJ in 83 patients and secondary in 17. Four types
of repairs, Anderson Hynes Dismembered (71), Y-V plasty (20), Heineke
Michuliz (8) and Davis intubated ureterotomy (1), were used. Type
of repair used was dictated by intra-operative findings. Twenty
patients had non-obstructing renal stones and underwent concomitant
pyelolithotomy. All patients were assessed for symptoms and obtained
radiographic evaluation for anatomical obstruction.
The average operating room time was 4.2 hours, but decreased with
surgeon experience. Average blood loss was 181 cc and hospital stay
3.3 days. Two patients required blood transfusion. A crossing vessel
was found in 57 patients. With a mean clinical and radiographic
follow-up of 2.7 and 2.2 years, 96% of the patients were free of
obstruction on follow-up radiographic imaging. Of the patients who
underwent concomitant pyelolithotomy, 18 (90%) were stone free at
last follow-up. All failures occurred within the first year. There
were 12 complications in this series.
In experienced hands, laparoscopic pyeloplasty is an effective alternative
treatment for symptomatic UPJO. The results appear durable and comparable
to open pyeloplasty with decreased post-operative morbidity.