A modified laparoscopic dismembered pyeloplasty on children with hydronephrosis

Objective:To investigate the therapeutic effect of transperitoneal laparoscopic dismembered pyeloplasty with modified anastomosis on children with hydronephrosis.Methods:For the reconstruction of ureter pelvic junction,simple interrupted anastomosis was substituted for interrupted and continuous anastomosis.Remaining the connection of the inside wall between the ureter and the renal pelvis,the lateral of the spatulated ureter was anastomosed to the caudally reflected renal pelvis using an interrupted suture for 3 stitches,and then the posterior wall was continuously anastomosed and then a double-J tube was placed.The obstructed ureteropelvic junction was then excised and the renal pelvis was trimmed.The remaining anterior half of the anastomosis was then completed with continuous anastomosis.The group using the new method of anastomosis was compared with the group using the simple interrupted anastomosis.Results:The operations were successful in all 23 cases by transperitoneal laparoscopic dismembered pyeloplasty,without conversion to open surgery.The operative time was 100-160min(mean,126min),the blood loss was 10-24ml with a mean of 14ml,none blood transfusion necessitated;the postoperative hospitalization was 4-7 days with a mean of 5.5 days;there was no serious complications found,such as intra-abdominal infection or intestinal adhesion;mere 2 patients were class-B healing;the perinephric urine drainage occurred in only 1 patient with 100ml/d,and disappeared 3 days after operation;the patients were examined with CT 6 months after operation,intermediate hydronephrosis in 2 individual kidneys(collecting systems separated from 1-1.2cm),mild in 5 individual kidneys(collecting systems separated less than 1cm) and resolution in others;the previous thinned renal cortex was significantly thickened.Conclusions:The interrupted and continuous anastomoses for the reconstruction of ureteropelvic junction on children with hydronephrosis have less operative time than the simple interrupted anastomosis for dismembered pyeloplasty.The blood loss,postoperative complications and therapeutic effect have no significant differences.