Transperitoneal left laparoscopic pyeloplasty with transmesocolic access to the pelvi-ureteric junction: technique description and results with a minimum follow-up of 1 year

To describe and evaluate the safety and outcome of transperitoneal left laparoscopic pyeloplasty (TLLP) with a direct approach to the pelvi-ureteric junction (PUJ) through the mesentero-colic space, which avoids mobilization of the descending colon. From March 2005 to June 2006, 18 consecutive patients underwent TLLP with direct access. For each patient age, gender, body mass index (BMI), hospital stay, skin-to-skin operative time, time from incision of the posterior peritoneum to dissection of the PUJ, blood loss, time to resumption of oral intake and complications were recorded. Statistical analysis was used to assess whether the body habitus (BMI < 25 kg/m(2) or > 25 kg/m(2)) affected the outcomes. There were no complications during or after surgery and no conversions to open surgery were needed. The mean (SD) time to resumption of oral intake was 1.36 (0.5) days. The mean hospital stay was 3.3 (0.67) days and the mean follow-up was 17.4 (4.7) months. There was no statistical difference between patients with BMI higher or lower than 25 kg/m(2) (P = 0.42). The success rate at 1 year after surgery was 100%. TLLP with direct access to the PUJ through the mesentero-colic space is a safe and effective technique. This approach should be considered for all patients with left primary PUJ obstruction who are eligible for a LP and especially for slim patients or patients with a large renal pelvis.