The vascular hitch procedure for pelvi-ureteric junction obstruction (PUJO) was initially described by Hellstroem in1951 and has become popular again since the introduction of laparoscopy. There is still much controversy as to its efficiency. The authors of this paper analyse their medium-term results of the laparoscopic hitch procedure performed between 2005 and 2012 on 70 children over the age of three years (mean 8.3, range 2.5-16 years). Nine children had a history of antenatal hydronephrosis, 57 (81%) children presented with symptoms of intermittent loin pain (including the 6/57 with history of prenatal diagnosis). Other diagnoses included: renal stones (n=2), episodes of febrile urinary tract infection (n=7) and / or hypertension, and incidental hydronephrosis in two. Preoperatively crossing vessels were seen in 50/70 children. The preoperative MAG-3 renal scan showed impaired drainage on diuretic renography in all patients, normal function in 38/70 cases, and in the remaining 32 with some functional impairment, the median renal split function was 30.2% (range 13-44). Operatively, 42 had a laparoscopic vessel transposition and 28 had this done robotically. Mean surgical duration was 120 minutes with no difference between the two methods. Median hospital stay was two days. Complications occurred in six (temporary urinary leak in three – treated with observation in one, bladder catheter in one, and ureteric stent in one; and failure in three – treated with a ureteric stent only in two and dismembered pyeloplasty after a nephrostomy in two). At a median follow-up at 52 months, success rate was 96% (reduction or resolution in hydronephrosis 67/70, improved drainage curves in 53/56 who had them). The authors discuss that the essential key to success is appropriate patient selection based on history and intraoperative findings. This is the largest series to date on this laparoscopic procedure.
Laparoscopic transposition of renal lower pole crossing vessels
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