ABSTRACT
To define the impact of the combined approach on the minimally invasive style of laparoscopic approach. From July 2005 to September 2007, 21 patients with unilateral primary pelvi-ureteric junction [PUJ] obstruction underwent Anderson Hynes pyeloplasty. Patients were divided into two groups. Group 1: consisted of 11 patients who had combined transperitoneal laparoscopic approach and then mini-open approach. The surgical procedure was divided into two steps: laparoscopic dissection of the renal pelvis and proximal ureter and then accomplishing the pyeloplasty through mini-flank [5 cm], muscle splitting incision which was planned under laparoscopic guidance to be accurately overlaying the PUJ. Group 2: consisted of 10 patients who underwent the whole procedure through laparoscopic approach. Perioperative records and postoperative assessment were compared between the two groups. The mean operating time [135 versus 189 min] and Analgesic requirement [90 versus 36 mg, morphine equivalent] were significantly different between group 1 and 2, respectively. There was no intraoperative complication in both groups and the postoperative complications were minor and similar in both groups [10%]. Postoperatively, time to resume the full activity was significantly different between the groups 1 and 2, at 2 weeks [54.0 versus 80%, respectively] however, it was similar [100%] at 4 weeks. Postoperative, assessment of the all patients, based on IVU and diuretic renogram at 3 and 6 months, were similar in both groups. Dismembered pyeloplasty through a combined approach save time and ensures high quality of anastomosis while maintaining the minimally invasive fashion of laparoscopic approach