Long-term Outcomes of Multi-institutional Minimally Invasive Appendiceal Onlay Ureteroplasty for Managing Complex Proximal Ureteral Strictures in Pediatric Patients.

PURPOSE: We report the long-term outcomes of laparoscopic and robotic-assisted appendiceal onlay ureteroplasty (AOU) for complex proximal ureteral (CPU) strictures in children across multiple institutions.

METHODS

Retrospective review of patients who underwent laparoscopic or robotic AOU for CPU between 2010 and 2020. Patient characteristics, perioperative surgical data, and follow-up data are described. The surgical approach was adjusted to the stricture length and location, involving a ventral incision or excision of the diseased ureter followed by repair with an onlay appendiceal flap. Success was established by the presence of symptomatic relief and the absence of obstruction on imaging assessments.

RESULTS

Twenty-nine patients underwent minimally invasive AOU of CPU (12 laparoscopy, 17 robot-assisted). The median age at surgery was 48 months (IQR, 36.5-69.0). The median stricture length measured 4.0 cm (IQR, 3.3-5.0), operative time was 162.0 min (IQR, 137.0-178.0), and estimated blood loss was 25.0 ml (IQR, 20.0-30.0). No open conversions and intraoperative complications occurred. Ventral-side onlay ureteroplasty was performed in 14 (48.3 %) patients (including two onlay augmented pyeloplasty) and Dorsal-side reconstruction ureteroplasty was performed in 15 (51.7 %) patients. Overall, 18 patients had grade Ⅰ or Ⅱ Clavien-Dindo postoperative complications and one patient developed a grade Ⅲ complication. Surgical success was achieved in 28/29 (96.6 %) patients at a median follow-up of 6.0 years (IQR, 5.0-7.5).

CONCLUSION

Minimally invasive AOU is a safe, feasible, and effective technique for managing CPU strictures in children with good long-term outcomes.