open pyeloplasty remains the gold standard for correcting ureteropelvic junction obstruction with a success rate between 90% to 98% .
although endopyelotomy and retrograde dilation are alternative methods of managing ureteropelvic junction obstruction in children , the success of these 2 procedures is inferior to that reported for conventional dismembered pyeloplasty .
laparoscopic pyeloplasty is rapidly becoming an acceptable procedure for ureteropelvic junction obstruction ( upjo ) in the pediatric population .
the advent of smaller instrumentation and more experience with intracorporeal suturing allows this well - accepted procedure in adults to be implemented in the pediatric population .
four children between 7 months to 8 years of age ( mean , 3.14 years ) underwent transperitoneal laparoscopic pyeloplasty for a upjo in a pelvic kidney . all patients except
the 7-month - old patient presented with antenatal diagnosed hydronephrosis , which worsened and was associated with parenchymal thinning of the pelvic kidney .
preoperatively , all patients had ultrasounds and diuretic radionuclide imaging ( dri ) evaluations consistent with upjo .
all patients underwent cystoscopic evaluation with retrograde ureteropyelogram ( rgp ) and stent placement before laparoscopic positioning ( figure 1 ) .
the transperitoneal laparoscopic approach previously described in the literature was implemented but slightly modified for the pelvic kidney .
one was placed lateral to the contralateral rectus in the midclavicular line at the level of the umbilicus ; another at the umbilicus to hold a 30-degree 3-mm laparoscope ; and the remaining one near the midaxillary line lateral to the ipsilateral rectus 3 cm medial and cephalad from the anterior superior iliac spine ( figure 2 ) .
three patients had a lower pole - crossing vessel , and 1 patient had a stenotic proximal segment .
all reap - proximations were performed with 6  0 polyglactic acid sutures in an interrupted fashion .
twelve sutures were placed at the upj with or without renal pelvis tapering , which was performed with a running 6  0 polyglactic acid suture .
all pyeloplasties were performed with a double pigtailed ureteral stent placed during cystoscopic evaluation at the onset of the procedure .
outcome measures included operative time , length of hospital stay , postoperative symptomatology , and resolution of obstruction by symptoms and ultrasonography , or dri , or both .
all the patients were followed with ultrasonography 2 months and then every 6 months after the procedure .
average operative time was 2.1 hours ( range , 1.5 to 2.8 ) . mean hospital stay was 2.15 days ( range , 1 to 7 ) . mean time to return to normal activity was 2 weeks ( range , 0.5 to 6 ) .
after surgical repair , all 3 patients ( 100% ) were completely pain free at a mean follow - up of 12 months .
all patients were evaluated 2 months postoperatively for an ultrasonographic evaluation revealing mild to moderate hydronephrosis . at a mean ultrasonographic follow - up of 11 months ( range , 6 to 20 ) , all 4 patients had resolution of the hydronephrosis .
current published data support at this time that it is not recommended in children younger than 6 months .
generally , the indications for laparoscopic pyeloplasty are identical to those of the open surgical approach , including failed previous retrograde or antegrade endopyelotomy .
we were able to mobilize the ureter sufficiently that a culp - deweerd spiral , scardino - prince vertical flap , or a dismembered tubularized renal pelvic wall flap described by gill et al were not necessary .
however , though the cohort is small , we feel that the same principles used in orthotopic laparoscopic pyeloplasty are easily recapitulated for the pelvic kidney .
even with a small number of patients , our results seem to show that laparoscopic pyeloplasty is an option for treating upjo in pelvic kidneys . we feel that the transperitoneal laparoscopic approach is feasible in this specific , complex , pediatric population .
 background : laparoscopic pyeloplasty is rapidly becoming an acceptable procedure for ureteropelvic junction obstruction in the pediatric population . 
 we present our experience with transperitoneal laparoscopic pyeloplasty for ureteropelvic junction obstruction in pelvic kidneys in pediatric patients.methods:a transperitoneal laparoscopic approach was used for performing a pyeloplasty in 4 patients , 7 months to 8 years of age ( mean age , 3.14 ) , with ureteropelvic junction obstruction in a pelvic kidney.results:average operative time was 2.1 hours ( range , 1.5 to 2.8 ) . 
 mean hospital stay was 2.15 days ( range , 1 to 7 ) . 
 no intraoperative complications were noted.conclusions:transperitoneal laparoscopic pyeloplasty for pelvic kidneys is feasible in the pediatric population , and preliminary results appear to offer the same outcome as that seen in orthotopic kidneys . 
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METHODS
RESULTS
DISCUSSION
CONCLUSION