الفهرس 
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Abstract
T
he Ureteropelvic junction obstruction (UPJO) is one of the most prevalent genitourinary abnormalities in children. The main issue with this obstructive disorder is the progressive deterioration in kidney function, which can lead to renal unit loss. There are many techniques for PUJO repair, but the Anderson-Hynes pyeloplasty remains the gold standard for surgical reconstruction.
Laparoscopic pyeloplasty (LP) is now widely recognized as a minimally invasive alternative for the surgical repair of uretero-pelvic junction obstruction (UPJO) in paediatrics. In this work, we aim to evaluate the feasibility, safety, and effectiveness of LP in our centre.
Between April 2019 and April 2021, patients presented with indication for surgical repair of UPJO were offered laparoscopic transperitoneal Anderson Hynes pyeloplasty. Demographic data, preoperative investigations, operative data, intra or postoperative complications, as well as short and mid-term follow up were recorded. During the specified period, 12 patients underwent LP (8 boys & 4 girls) with a median age of 12 months (range from 6 to 144 months). There was no conversion to open approach with operative time ranging from 120 to 240 minutes (Mean =174 ± 36 min). No intra or postoperative complication were encountered.
Follow-up PAUS showed a reduction in the antero-posterior diameter of the renal pelvis, and improvement in parenchymal thickness in all cases. Postoperative diuretic renal scans (DTPA renography) were done for those with a persistent anteroposterior diameter of the renal pelvis greater than 20 mm which showed improvement in the washout. All patients had a good cosmetic outcome.
We concluded that laparoscopic pyeloplasty is a safe, feasible, and effective technique in managing UPJO in children and infants. It has a good cosmetic outcome; however, the operative time was longer than standard open procedure.
Our study is limited by the small cohort size, and it is not comparative to the traditional open approach, with relatively short follow-up period which can potentially affect the assessment of late surgery failure.
CONCLUSION AND RECOMMENDATIONS
M
inimally invasive approach is the preferred approach nowadays worldwide for both the surgeons and the patients in the management of UPJ obstruction. Laparoscopic pyeloplasty is feasible and safe in paediatrics. It has good functional and cosmetic outcome. The drawbacks are the longer operative time and the higher learning curve needed. Also specialized centre is an essential step in this technique.
Further studies are needed to assess the exact outcome of the procedure. More patients should be included. Longer follow up is needed for long term results and to detect any late complications. Comparative studies with the established technique in our centre are a must to compare outcome. Finally, a standardised training programme should be established for the trainees, in order to have experts in reasonable time, and before replacing the open technique by the laparoscopic one as the standard procedure.