Evaluation of Transperitoneal Laparoscopic Dismembered Pyeloplasty for Pelviureteric Junction Obstruction in Children

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Background:Pelviureteric junction obstruction (UPJO) is a leading cause of hydronephrosis in children and may result in progressive renal impairment. Laparoscopic pyeloplasty has emerged as a minimally invasive alternative to open repair, with potential advantages of reduced morbidity and improved cosmesis.The current study was conducted to assess the practicality, safety profile, and postoperative functional outcomes of the transperitoneal laparoscopic approach for pyeloplasty in children diagnosed with UPJO.Methods:Between August 2022 and August 2024, 24 children with primary UPJO underwent laparoscopic dismembered pyeloplasty at our institution. Inclusion criteria were age >6 months and <14 years, renal pelvic anteroposterior diameter (APD) >30 mm or >20 mm with calyceal dilatation, differential renal function (DRF) <40%, >10% inter-side difference in DRF, or symptomatic presentation (pain, hematuria, recurrent urinary tract infections). Patients with recurrent UPJO, solitary kidney, or secondary causes were excluded. Outcomes were assessed by operative parameters, perioperative complications, resolution of obstruction, and improvement in renal function and drainage.Results:The anteroposterior diameter (APD) of the renal pelvis significantly declined from 34.92 ± 8.33 mm before surgery to 14.75 ± 3.18 mm after six months (p < 0.05). Split renal function (SRF) improved from 37.25 ± 6.74% to 40.92 ± 6.95% (p < 0.05). A favorable anatomical and functional outcome was observed in 23 of 24 patients (95.8%).Conclusions:Transperitoneal laparoscopic pyeloplasty is a safe and effective approach for managing UPJO in children, offering high success rates, functional improvement, and favorable cosmetic outcomes with minimal morbidity.

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