Comparative perioperative and follow-up outcomes of three laparoscopic reconstructive procedures for pediatric duplex kidney

This study aimed to describe and compare perioperative characteristics, postoperative recovery, complications, and observed follow-up outcomes among children undergoing 3 laparoscopic renal-preserving reconstructive procedures selected according to anatomical and functional characteristics. This retrospective cohort study included children with duplex kidney who underwent laparoscopic renal-preserving reconstructive surgery between January 2016 and December 2025. Patients were divided into 3 groups according to the surgical procedure performed. Baseline characteristics, preoperative anatomical findings, surgical indications, operative outcomes, postoperative recovery, complications, and follow-up outcomes were compared among the groups. Additional pairwise comparison was performed between pelvic-level end-to-side ureteroureterostomy (UU) and upper-pole ureteral bladder reimplantation. A total of 91 children were included: 29 who underwent renal pelvic-level upper-pole ureter to lower-pole renal pelvis anastomosis, 36 who underwent pelvic-level end-to-side UU, and 26 who underwent upper-pole ureteral bladder reimplantation. Baseline demographic characteristics were comparable among the 3 groups. Significant differences were observed in anatomical features and surgical indications. Markedly dilated or obstructed upper-pole ureters were more frequent in the renal pelvic-level ureteropyelostomy and pelvic-level end-to-side UU groups, whereas distal upper-pole ureteral abnormality and reflux-related indications were more common in the upper-pole ureteral bladder reimplantation group. Operative time differed significantly among the 3 groups, with the shortest time observed in the pelvic-level end-to-side UU group. Estimated blood loss was also lowest in this group. Pairwise comparison showed that pelvic-level end-to-side UU was associated with significantly shorter operative time and lower estimated blood loss than upper-pole ureteral bladder reimplantation. Laparoscopic renal pelvic-level upper-pole ureter to lower-pole renal pelvis anastomosis, pelvic-level end-to-side UU, and upper-pole ureteral bladder reimplantation appear to be feasible and effective renal-preserving reconstructive procedures for pediatric duplex kidney when selected according to anatomical and functional characteristics. Pelvic-level end-to-side UU was associated with shorter operative time and lower estimated blood loss than upper-pole ureteral bladder reimplantation when a suitable ipsilateral recipient ureter was available. No statistically significant between-group differences were detected in postoperative recovery, complications, or the measured follow-up outcomes. These findings should be interpreted in the context of anatomy-based procedure selection rather than as evidence of equivalent effectiveness.