384 / 492
VR-23
(VS)
LAPAROSCOPIC RETROPERITONEAL APPROACH FOR RETROCAVAL URETER IN
CHILDREN
Matthieu PEYCELON
1
, Grégory REMBEYO
1
, Anca TANASE
2
, Cécile Olivia MULLER
1
, Thomas BLANC
1
, Hamdan ALHAZMI
1
,
Annabel PAYE-JAOUEN
1
and Alaa EL GHONEIMI
1
1) Robert-Debré University Hospital, AP-HP; Université Paris Diderot, Sorbonne Paris Cité, Pediatric Surgery and
Urology, Paris, FRANCE - 2) Robert-Debré University Hospital, AP-HP; Université Paris Diderot, Sorbonne Paris Cité,
Pediatric Radiology, Paris, FRANCE
PURPOSE
Retrocaval ureter (RCU) is a rare congenital anomaly and published data on pediatric laparoscopic management are
poor. The aim of this study was to report our experience of retroperitoneal laparoscopic approach for management of
RCU in children.
MATERIAL AND METHODS
A retrospective review of data from patients treated for RCU between 2002 and 2015 was performed. All patients were
placed in a flank position and underwent a three-port (5-mm optical trocart and two 3-mm trocarts) laparoscopic
retroperitoneal ureteroureterostomy. Anastomosis was made by 6/0 absorbable sutures. A JJ stent was always inserted.
RESULTS
Five patients with a median age of 94 months (5-152) were operated on and followed up for a median time of 58
months (1-155). Median operating time was 200 minutes (160-270). No conversion and no transfusion occurred. Median
hospital stay was 2 days (1-4). Ureteral stent was removed after 52 days (47-82). Complications included UTI (N=1). In
all cases, hydronephrosis decreased postoperatively.
N
Age
(months)
Symptoms
Preoperative
imaging
Preoperative
diagnosis
Postoperative
diagnosis
Surgical techniques
1 137,3
UTI
US, MAG3
renography
PUJO
RCU
Resection of ureter -
Ureteroureterostomy
2 5,2
Antenatal
diagnosis
US, MAG3
renography,
uroRMI
PUJO
RCU
Resection of PUJ and ureter -
Pelvi-ureteric anastomosis
3 94,5
Hematuria and
lithiasis
US, UroCT scan
RCU with
suspended
lithiasis
RCU
Resection of PUJ and ureter -
Pelvi-ureteric anastomosis
4 151,6
Hematuria and
flank pain
US, UroRMI
RCU
RCU
Resection of ureter -
Ureteroureterostomy
5 16,8
Antenatal
diagnosis
US, MAG3
renography
PUJO
RCU
Resection of PUJ and ureter -
Pelvi-ureteric anastomosis
CONCLUSIONS
Retroperitoneal laparoscopic approach for RCU is safe and effective in children. Our video demonstrates different
patients with specific surgical details to show how to manage these children. The global vision of the upper tract by
laparoscopy leads to optimal management of these children even if the anomaly was not detected preoperatively.