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LAPAROSCOPIC DISMEMBERED FLAP PYELOPLASTY IN CHILDREN
Radim KOCVARA, Josef SEDLACEK, Petr MACEK, Vojtech FIALA and Tomas HANUS
General Teaching Hospital and Charles University 1st Medical School in Prague, Department of Urology, Prague 2,
CZECH REPUBLIC
PURPOSE
Laparoscopic dismembered flap pyeloplasty using vertical flap has been reported in a few paediatric cases only. The
video shows feasibility of laparoscopic creation of a pelvic flap described by Kučera in order to bridge a longer ureteral
stenosis or renal isthmus of the horse-shoe kidney.
MATERIAL AND METHODS
During 2003-2014, laparoscopic flap pyeloplasty was performed in 13 patients (in seven children 2-17 years old, and in
six adults). It was indicated in intrarenal U-P junction with crossing vessels(3), in malrotated kidney(4), in horse-shoe
kidney(3) and in redo surgery(3) in order to attain a tension free anastomosis.The video shows flap pyeloplasty in
horse-shoe and in malrotated kidney. The upper part of the pelvis is stabilized with a traction suture. The ureter is
ligated at the U-P junction and divided. Proximal part of the dilated pelvis is incised laterocaudally. The lower lip of the
incised pelvis is flipped caudally creating a funnel thus prolongating the course of the pelvis. The ureter is spatulated
and anastomosed to the lowest end of the pelvis with continuous 5-6/0 polyglactin suture. A double-J stent is inserted.
RESULTS
The mean operation time was 272 minutes (180 to 455); a calyceal stones was removed in one patient. One patient
required replacement of a stent because of blood clots. Obstruction has been released in all patients.
CONCLUSIONS
Kučera flap pyeloplasty moves pyeloureteric anastomosis more distally preserving wide continuity with the pelvis and
sufficient blood supply. It is indicated in anatomically selected group of patients. In our hands, this modification has
replaced Culp/DeWeerd spiral or Scardino/Prince vertical flaps and can be performed by laparoscopy.