To discuss the feasibility and summarize the experiences of laparoscopic transperitoneal and transmesenteric surgery for symptomatic nephrohydrosis with horseshoe kidney.

The hospital registry of patients with intractable nephrohydrosis in horseshoe kidney from September 2017 to December 2018. 4 males and 1 female patients with the mean age of 51.7 years were admitted, and imaging showed horseshoe kidney [4 cases with moderate hephrohydrosis (two cases with kidney stone, 1 patient with severe nephrohydrosis and medullary cystic kidney and the ureteropelvic junction obstruction (UPJO)]. All patients were eligible for laparoscopic surgery. Patients placed in supine position with general anesthesia, all procedures were finished successfully with a transmeseteric approach using four or five trocars placement. Firstly, rolled and suspended the intestine with hanging and fastening method and exposure of mesentery, with a thorough dissection of mesentery blood vessels. The ascending portion of the duodenum was visualized and moving along the ascending colon. Secondly, isolation of the isthmus on the fascia of infrarenal abdominal aorta was performed, and separation the isthmus and preparation of blood vessels from the surrounding tissues. Finally, raised the isthmus upward and cut by endostapler, suturing the edges of the isthmus upper and lower on both sides. For the UPJO, it was removed with the routine Anderson-Hynes technique and the anastomosis was conducted by 2 separate and running sutures.

The operating time was 126-178 minutes and the estimated blood loss was 50-110 ml, respectively. The average hospital stay was 5-7 days and the D-J stents were removed 1 month after surgery. No bowel disorders were observed and renal function imaging showed good effects of operation within 3-20 months follow-up.

Laparoscopic transmesenteric isthmusectomy could be a reasonable procedure for selected cases with horseshoe kidney, combined with clear visual field and safety.