Vol. 6, Issue 1, Part C (2024)

Ureteropelvic junction obstruction (UPJO) remains the most common pathology of the ureter and the main obstructive uropathy in children. Minimally invasive techniques to treat UPJO including laparoscopic pyeloplasty have been developed in the recent years. This quasi-experimental study, conducted in the Department of Urology at NIKDU, Dhaka, from March 2022 to August 2023, compared the outcomes of the transmesocolic (TMC) and lateral colic (LC) approaches for left-sided laparoscopic pyeloplasty in pediatric patients. A total of 30 pediatric patients were selected using purposive sampling and divided into the Lateral colic and Transmesocolic groups. Statistical analysis was performed using unpaired t-tests for quantitative outcomes and Chi-square (ꭓ2) or Fisher’s exact tests for categorical outcomes. A 95% confidence interval was applied, and a p-value of < 0.05 was considered statistically significant. This study results revealed that, of the initial participants, two patients from the LC group and one from the TMC group were lost to follow-up, leaving a total of 27 patients (LC=13, TMC=14) for analysis. Baseline demographics were similar between the two groups. The mean operative time was significantly shorter in the TMC group (86.21±8.27 minutes) compared to the LC group (109.0±6.30 minutes, p<0.001). Intraoperative blood loss was also significantly lower in the TMC group (28.57±7.70 ml) compared to the LC group (51.54±22.02 ml, P=0.003). However, there was no significant difference between the groups in terms of postoperative pain, hospital stay, complications (such as fever, paralytic ileus, and urine leakage), or improvement in renal function of the affected kidney. In conclusion, the transmesocolic approach demonstrated a comparable success rate to the lateral colic approach, with advantages of shorter operative time and reduced intraoperative bleeding. Nevertheless, the TMC approach requires expertise due to the potential risk of mesenteric vessel injury.