2008, Number 3
Acta Pediatr Mex 2008; 29 (3)
Landa-Juárez S, López-Pérez D, Miguel-Gómez RD, Andraca-Dumit R
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ABSTRACTIntroduction: Traditionally therapeutic peritoneal laparoscopic approach for ureteropelvic junction stenosis (UPJS) has been retrocolic, taking down the colon and mesentery medially in order to expose the ureter and the renal pelvis. This dissection is avoided with the transmesentery approach, which is the subject of this paper. Material and method: Between 2005-2006, we performed 52 pyeloplasties for UPJS; only eleven were done by laparoscopy (two retrocolic and nine transmesenteric). The patient is placed in a lateral position with slight angulation of the surgical table. With the intestinal loops displaced to the midline the colon mesentery is incised avoiding damage of vascular structures. The UPJ and the type of stenosis was identified. The pelvis at the level of the UPJ is retracted with a transparietal suture; the ureter is incised laterally two cm and is then anastomosed to the pelvis with a continuous suture. A double “J” catheter is placed and the anterior wall of the anastomosis is sutured. The absence of bleeding or leakage is verified and a Penrose drainage is used. Results: Eleven laparoscopic peritoneal pyeloplasties were done. Nine of them were trasmesenteric in the left kidney. Patients’ age was 9 months to 15 years (average of 7.87). Surgical time was 180 to 330 minutes (average of 255). There was one complication, stenosis in one anastomosis in a patient in whom a double “J” catheter was not used. Discussion: The transmesenteric laparoscopic approach allows ample and quick dissection of the UPJ with minimal mobilization of abdominal organs. The distended renal pelvis with a double “J” catheter permitt to identify the site and type of stenosis thus avoiding a preoperatory cistoscopy. The disadvantages of the transmesocolic approach are limited to the left kidney and that it requires experience in the handling of the instruments to avoid prolonged surgical time. The outcome in solving the obstruction was similar to that obtained with the open technique.