Laparoscopic Transperitoneal Dismembered Pyeloplasty by Anderson-Hynes Procedure in Left Pelviureteric Junction Outlet Obstruction of a Horseshoe Kidney: A Case Report

Horseshoe kidney (HSK) is the most common renal fusion anomaly.The most common complication is Hydronephrosis, secondary to pelviureteric junction obstruction (PUJO).Less than 30 cases of minimally invasive reconstructive HSK procedures have been reported worldwide, starting in 1996.Unfamiliar caudal anatomy, aberrant lower pole vessels, and renal isthmus make laparoscopic pyeloplasty difficult.We report a case of PUJO in an HSK patient and a coexisting ventricular septal defect (VSD), who was managed with laparoscopic pyeloplasty.A 23-year-old woman presented to the outpatient department with complaints of dull, aching pain in the left flank for the past year.There were no urinary complaints.There is a history of a VSD, which was surgically corrected at the age of 10.The patient was stable on examination, with no pallor, icterus, or edema.A midline sternotomy scar was seen.The abdomen was non-tender, with no organomegaly.The serum urea and creatinine were normal, and she had sterile urine.Abdominal ultrasound revealed an HSK.A renogram revealed left-sided hydronephrosis, with significant radiotracer retention in the pelvicalyceal system during delayed images, diagnostic of PUJO.A laparoscopic transperitoneal dismembered pyeloplasty was performed.The double-J stent was removed six weeks post surgery.A renogram performed 10 months after surgery showed mild hydronephrotic left moiety with a slow, non-obstructive clearance.Despite being technically challenging owing to altered anatomy, laparoscopic pyeloplasty should be the treatment for HSK, with success rates comparable to open pyeloplasty and lesser post-operative morbidities.