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Laparoscopic pyeloplasty compared with open pyeloplasty in children
I R Ravish1, R B Nerli, Mallikarjun N Reddy
1Department of Urology, KLES Kidney Foundation, KLES Hospital & MRC, Karnataka, India. irravish@yahoo.com
Insights
Laparoscopic pyeloplasty in children offers a high success rate with reduced postoperative pain and shorter hospital stays compared to open surgery. While operative times are longer, it leads to quicker recovery for ureteropelvic junction obstruction.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Surgical Outcomes
Background:
- Open dismembered pyeloplasty via a retroperitoneal approach is the standard for pediatric ureteropelvic junction (UPJ) obstruction.
- Laparoscopic pyeloplasty presents an alternative surgical technique.
Purpose of the Study:
- To prospectively compare the outcomes of laparoscopic pyeloplasty versus open pyeloplasty in children with UPJ obstruction.
Main Methods:
- A prospective study comparing 15 children undergoing laparoscopic pyeloplasty with 14 children undergoing open pyeloplasty.
- Analysis of operative time, postoperative pain, activity, complications, and hospital stay.
- Mean follow-up of 23 months (laparoscopy) and 24 months (open surgery).
Main Results:
- Open pyeloplasty had significantly shorter operative times (159 min vs. 214 min).
- Laparoscopic pyeloplasty resulted in significantly less postoperative pain on day 7 and shorter hospital stays.
- No significant difference in success rates was implied, with comparable outcomes.
Conclusions:
- Laparoscopic pyeloplasty demonstrates a high, reproducible success rate comparable to open pyeloplasty for UPJ obstruction in children.
- Benefits include minimal morbidity (pain) and a faster return to normal activities.
- Despite longer operative times, laparoscopic pyeloplasty significantly reduces hospital stay.
Background And Purpose:
Open dismembered pyeloplasty by a retroperitoneal approach remains the reference standard for correcting ureteropelvic junction (UPJ) obstruction in children. We prospectively compared the results of laparoscopic and open pyeloplasty in children with UPJ obstruction.
Patients And Methods:
During the period April 2003 to March 2005, 15 children underwent laparoscopic pyeloplasty and 14 children underwent open pyeloplasty. The two groups were similar in age and mean weight. We prospectively analyzed and compared operative time, postoperative pain and activity, complications, and hospital stay in the two groups. The mean follow-up was 23 and 24 months in the laparoscopy and open surgery group, respectively.
Results:
The mean operative time was significantly shorter in the open surgery group (159 +/- 21.39 [SD] v 214 +/- 32.26 minutes; P = 5.874 x 10(-6)). Postoperative discomfort/pain on day 7 was significantly less in the laparoscopic group, and the mean hospital stay was significantly shorter (P = 0.018019).
Conclusions:
The benefits of laparoscopic pyeloplasty include a high reproducible success rate comparable to the results achieved by open pyeloplasty. Our results indicate minimal morbidity such as pain and a quick return to normal activities. The hospital stay is significantly reduced, although the operative times are long compared with open pyeloplasty.
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