Backround: To examine the early experience of laparoscopic pyeloplasty for the treatment of ureteropelvic junction obstruction (UPJO) in the pediatric population, performed at a single institution by a single surgeon.
Methods: From November 2001 to January 2005, 21 consecutive patients underwent transperitoneal laparoscopic pyeloplasty for the treatment of symptomatic and radiographic UPJO. Data was collected retrospectively. Patients were followed at regular intervals with imaging studies and symptom assessment. Failure was defined as inability to complete the intended procedure, persistent flank pain, radiographic evidence of obstruction, or the need for adjunctive procedures
Results: The mean patient age was 10.6 years (range 1-19), and follow-up was available on all 21 patients with a mean duration of 8.1 months (range 1-26). Five patients had prior treatment for the obstruction. Procedures performed included 18 laparoscopic Anderson-Hynes pyeloplasties, 2 laparoscopic Heineke-Mikulicz pyeloplasties, and 1 laparoscopic pyeloureterostomy. All 21 cases were completed. Three ports were used in all cases. Mean operating time was 301 minutes (range 212-410), which included positioning and concomitant procedures (cystoscopy). There was a trend towards decreased operative time with the latter cases. Twelve patients had lower pole crossing vessels. Average length of stay was 1.5 days (range 1-3), and no intraoperative or post-operative complications occurred. Post-operative ultrasound has been performed in 20 patients, of which 19 (95%) demonstrated a normal exam. By our definition, we had only 1 patient (4.7%) with failure who continued to have symptomatic and radiographic evidence of obstruction with the need for additional adjunctive procedures.
Conclusions: Laparoscopic pyeloplasty for UPJO in the pediatric population is technically challenging, however, with experience, excellent success rates with few complications can be expected. Our experience reinforces laparoscopic pyeloplasty as the new gold standard for treatment of UPJ obstruction in children.

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