Laparoscopic dismembered pyeloplasty for ureteropelvic junction obstruction: experience with 142 cases in a high-volume center

Background and Purpose: Laparoscopic dismembered pyeloplasty (LDP) is a minimally invasive approach that is becoming standard management of ureteropelvic junction obstruction (UPJO). It provides similar results when compared with open surgery. The main goal of LDP is to meet the standard of open dismembered pyeloplasty with reduced trauma for the patients. The purpose of the study was to evaluate the postoperative and functional results of LDP. Patients and Methods: We retrospectively reviewed and analyzed 142 cases of LDP performed at our center over a period of 7 years (January 2003 to December 2009) for UPJO with dilatation of the renal pelvis. Patients' profiles and perioperative, intraoperative, and postoperative parameters, such as time of surgery, blood loss, complications, duration of hospital stay, and outcomes of the procedure, were all evaluated and analyzed. Results: The mean operative time for LDP was 145 minutes (range 110-180 min), and the mean estimated blood loss was negligible in all patients. The mean hospital stay was 3.5 days (3-6 d). Two conversions to open surgery occurred because of difficulty to complete the anastomosis. In one patient, shock caused by bleeding from inferior epigastric vessels near the port site developed and had to be explored. The success rate was 96.8%. Conclusion: When performed by expert surgeons, LDP can safely achieve success rates that are comparable to those of open surgery described in the literature, with fewer complications and less morbidity to the patients. The few important difficulties with their management that we encountered are discussed.