LAPAROSCOPIC TRANSPERITONEAL PYELOPLASTY FOR URETEROPELVIC JUNCTION OBSTRUCTION IN PAEDIATRIC POPULATION GROUP

Background: Ureteropelvic junction obstruction (UPJO) is one of the most prevalent genitourinary abnormalities in children. PUJO is considered as the most common cause of congenital hydronephrosis. Pyeloplasty is the main treatment method for patients with UPJO [5]. An ideal treatment should have the highest success rate and be minimally invasive. There are many techniques for PUJO repair but dismembered Anderson Hynes pyeloplasty remains the gold standard for surgical reconstruction[8]. Laparoscopic Anderson-Hynes pyeloplasty has become the gold standard in many pediatric centers. Objectives: To assess the safety and efficacy of laparoscopic transperitoneal pyeloplasty in children with PUJ obstruction. Methods: The study included 30 consecutive cases of congenital unilateral PUJO with SRF <40% managed during the 24-month period from November 2020 to November 2022. All the patients were properly evaluated before proceeding with the procedure. Results: In our study, the mean age of patients was 6.4 years. Most of the children affected were males (76.7%) and involvement of the left pelvi-ureteric junction. The commonest cause of pelvi-ureteric junction obstruction was an abnormal proximal segment (53.3%) followed by a crossing vessel (20%). The pre-op APPD on ultrasonography was in the range from 21mm to 50mm, with a mean pre-op APPD of 36.26mm. Most of the patients (83%) had a pre-operative differential renal function in the range of 31-40%(34.8%). The mean operative time was 99.06 mins. Mean post-op APPD was 27.38mm and DRF was 40.72%. 96% of the patients had an indwelling catheter in situ for a period of less than one week. Out of the total of 30 patients anastomotic drain was kept for 6 days in 28 patients (93.34%). The mean hospital stay in days was 7.53 days. Conclusion: Laparoscopic transperitoneal pyeloplasty is a safe and effective, minimally invasive procedure in pediatric patients, characterized by good surgical efficiency, reduced complications, faster recovery, and satisfactory follow-up results.