OBJECTIVE: To compare the transmesocolic approach in the left laparoscopic pyeloplasty with the laterocolic right-side repair in children. PATIENTS AND METHODS: Dismembered pyeloplasty was performed in 77 consecutive children aged 1.2-18.2 years. The transmesocolic approach was used in 49 patients with left hydronephrosis (group I) and the conventional laterocolic approach in 28 patients with right hydronephrosis (group II). Three age groups were defined. RESULTS: The transmesocolic approach was applicable in 48 of 49 patients (98%); the colic vessels were preserved. The operation time was significantly shorter in the transmesocolic group, also when comparing patients with similar age, incidence of crossing vessels and urinary diversion. A shorter operation time was achieved in children without internal urine diversion. Postoperative complications were encountered in 6.3% of group I and 7.1% of group II without any conversion to open repair or recurrence of obstruction within a 2.5-year follow-up period. CONCLUSIONS: The transmesocolic approach offers clear anatomy and provides safe access to the dilated left renal pelvis and crossing vessels. The operative time is shorter due to very limited tissue dissection. The medial reflection of the colon is avoided. This approach allows for microsurgical performance of the left-side pyeloplasty in all paediatric age groups.

Department of Urology General Teaching Hospital and 1st Medical School of Charles University Ke Karlovu 6 128 08 Praha 2 Czech Republic

Institute for Postgraduate Medical Education Ruská 85 100 05 Praha 10 Czech Republic

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