Purpose Routine scintigraphy after surgery for uretero-pelvic junction obstruction (UPJO) is discouraged, making ultrasound the preferred option for follow up. Yet, interpretation of sonographic parameters is rarely straightforward. Methods We reviewed 111 cases including 97 pyeloplasty (52 open, 45 laparoscopic) and 14 pyelopexy, during a 7-year period. Pre- and postoperative pelvic Antero-Posterior Diameter (APD), Cortical Thickness (CT) and Pelvic/Cortex Ratio (PCR) was measured serially. Results 85% were free of symptoms by 1 year. Only 11% had complete resolution of hydronephrosis. Eleven (10.4%) needed a redo procedure. Mean reduction in APD was 32.6%, 45.8%, and 51.7% at 6 weeks, 3 and 6 months respectively. CT increased by an average 55.9%, 75.6% and 107.6% while PCR reduced by 6.9, 8.0 and 8.8 at given intervals. Comparison of open and laparoscopic procedures showed no significant difference. Review of failed pyeloplasty showed failure of reduction in APD (APD > 3cm or < 25% reduction) and PCR (PCR > 4) as early indicators for failure. Conclusion Both APD and PCR are reliable indicators of success and failure following pyeloplasty while CT alone is not as useful. Laparoscopic procedures are non-inferior to standard open surgery.

Routine scintigraphy after surgery for uretero-pelvic junction obstruction (UPJO) is discouraged, making ultrasound the preferred option for follow up. Yet, interpretation of sonographic parameters is rarely straightforward. MethodsWe reviewed 111 cases including 97 pyeloplasty (52 open, 45 laparoscopic) and 14 pyelopexy, during a 7year period. Pre-and postoperative pelvic Antero-Posterior Diameter (APD), Cortical Thickness (CT) and Pelvic/Cortex Ratio (PCR) was measured serially. Results85% were free of symptoms by 1 year. Only 11% had complete resolution of hydronephrosis. Eleven (10.4%) needed a redo procedure. Mean reduction in APD was 32.6%, 45.8%, and 51.7% at 6 weeks, 3 and 6 months respectively. CT increased by an average 55.9%, 75.6% and 107.6% while PCR reduced by 6.9, 8.0 and 8.8 at given intervals. Comparison of open and laparoscopic procedures showed no signi cant difference. Review of failed pyeloplasty showed failure of reduction in APD (APD > 3cm or < 25% reduction) and PCR (PCR > 4) as early indicators for failure. ConclusionBoth APD and PCR are reliable indicators of success and failure following pyeloplasty while CT alone is not as useful. Laparoscopic procedures are non-inferior to standard open surgery.

Purpose Outcome data after Kasai Portoenterostomy (KPE) reported worldwide shows considerable regional and institutional variation. It is not known whether the same standards of outcomes reported in western world can be replicated in resource-poor countries. Methods We reviewed 79 patients of which 43 had completed a 2-year minimum follow-up. Two cohorts were based on age at KPE. Median age at surgery was 60 days. Results Clearance of jaundice (COJ) at 3 months was 20.93% and was not affected by age at surgery (p = 0.295). Four patients (9.3%) received liver transplant and 16 patients (37.21%) were recorded dead at a median age of 7 months. Native liver survival (NLS) was 53.49% and Overall survival (OS) was 62.79%. Kaplan-Meier estimated 4- and 6-year NLS were 55.8% and 49.6% respectively. There was a significant difference in the NLS between early and late surgery groups. Conclusion Whilst causes for low COJ need to be explored, this data reaffirm that early surgery has a significant favorable effect on survival. NLS was comparable with data from the developed world whereas low OS is explained by limited access to transplant. Thus, where the survival depends on native liver longevity, emphasis should be on as early KPE as possible.

Outcome data after Kasai Portoenterostomy (KPE) reported worldwide shows considerable regional and institutional variation. It is not known whether the same standards of outcomes reported in western world can be replicated in resource-poor countries. MethodsWe reviewed 79 patients of which 43 had completed a 2-year minimum follow-up. Two cohorts were based on age at KPE. Median age at surgery was 60 days. ResultsClearance of jaundice (COJ) at 3 months was 20.93% and was not affected by age at surgery (p = 0.295).Four patients (9.3%) received liver transplant and 16 patients (37.21%) were recorded dead at a median age of 7 months. Native liver survival (NLS) was 53.49% and Overall survival (OS) was 62.79%. Kaplan-Meier estimated 4-and 6-year NLS were 55.8% and 49.6% respectively. There was a signi cant difference in the NLS between early and late surgery groups. ConclusionWhilst causes for low COJ need to be explored, this data rea rm that early surgery has a signi cant favorable effect on survival. NLS was comparable with data from the developed world whereas low OS is explained by limited access to transplant. Thus, where the survival depends on native liver longevity, emphasis should be on as early KPE as possible.