Laparoscopic transposition of lower pole crossing vessels (vascular hitch) in children with pelviureteric junction obstruction

Uretero-pelvic-junction obstruction (UPJO) may be caused by intrinsic disorganization or by extrinsic compression from crossing vessels (CV); extrinsic causes usually present symptomatically in older children. The association was first described by Von Rokitansky in 1842 (1-3). Open or Laparoscopic Dismembered Pyeloplasty is the gold standard procedure to treat UPJO since the procedure was first described by Anderson and Hynes (AHDP) in 1949 (4). An alternative approach to pure extrinsic-UPJO was described by Hellstr？m (5) in the same year, it involved displacing the lower pole vessels cranially and then anchoring them to the anterior pelvic wall using vascular adventitial sutures. Chapman (6) further modified this technique by securing a more superior position of the lower pole vessels within a wrap of the anterior pelvic wall without the need for vascular adventitial sutures. This technique has since been described in children as an alternative to open dismembered pyeloplasty, with the largest series reported in 1999 by Pesce (7)