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Cytokine responses following laparoscopic or open pyeloplasty in children
Longxin Wang1, Weijun Qin, Feng Tian
1Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China. wanglx9@fmmu.edu.cn
Insights
Laparoscopic pyeloplasty (LP) in children shows a reduced inflammatory response and shorter hospital stays compared to open pyeloplasty (OP). Both procedures are safe for ureteropelvic junction obstruction, but LP offers potential benefits.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Inflammatory Response
Background:
- Ureteropelvic junction obstruction is a common congenital anomaly in children.
- Open pyeloplasty (OP) has been the traditional surgical approach.
- Laparoscopic pyeloplasty (LP) offers a minimally invasive alternative.
Purpose of the Study:
- To compare the cytokine response in children undergoing LP versus OP.
- To evaluate postoperative inflammatory markers, procedure duration, and clinical outcomes.
- To assess the safety and efficacy of both surgical techniques.
Main Methods:
- 31 pediatric patients (2.5-14 years) with ureteropelvic junction obstruction were studied.
- 14 patients underwent LP, and 17 underwent OP.
- Serum levels of IL-1beta, IL-6, IL-8, IL-10, TNF-alpha, and CRP were measured preoperatively and at 4, 24, and 48 hours postoperatively using ELISA. Procedure duration, hospital stay, and complications were also compared.
Main Results:
- Both LP and OP showed significant elevations in IL-6 and CRP postoperatively.
- The increase in IL-6 and CRP was significantly greater following OP compared to LP.
- LP resulted in a significantly shorter hospital stay (5.3 days) than OP (9.3 days), despite a longer procedure duration. No severe complications or significant differences in recurrence rates were observed between groups.
Conclusions:
- Both OP and LP are safe and effective for pediatric ureteropelvic junction obstruction.
- LP demonstrates a potentially reduced inflammatory response and shorter hospital stay.
- These findings suggest potential advantages of LP over OP in pediatric pyeloplasty.
Background:
The present study evaluated the cytokine response in children following laparoscopic pyeloplasty (LP) or open pyeloplasty (OP). A series of cytokines were measured postoperatively, including interkin1-beta (IL-1beta), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), tumor necrosis factor-alpha (TNF-alpha), and C-reactive protein (CRP).
Methods:
A total of 31 patients, with an average age of 9.1 +/- 3.0 years (range 2.5-14 years) were studied. Fourteen patients underwent LP and 17 underwent OP. Blood serum concentrations of IL-1beta, IL-6, IL-8, IL-10, TNF-alpha, and CRP were measured via enzyme-linked immunosorbent assay (ELISA) before surgery as well as 4, 24, and 48 h following the operation. In addition, the procedure duration, hospital stay, incidence of wound infection, and the recurrence rate of stenosis in both groups were compared.
Results:
Serum IL-6 and CRP concentrations were significantly elevated in both groups at 4, 24, and 48 h relative to preoperative levels. However, the rise in IL-6 and CRP in OP group was significantly more robust than in LP group. No significant changes were observed in serum levels of IL-1beta, IL-8, IL-10, or TNF-alpha in either group. The procedure duration was significantly longer for LP (193.6 +/- 74.7 min, range 120-360 min) versus OP (120.1 +/- 27.5 min, range 90-165 min, p < 0.05), but the hospital stay following LP was shorter (LP group: 5.3 +/- 1.1 days versus OP group: 9.3 +/- 2.1 days, p < 0.05). No severe complications were noted in either group, however, one child experienced wound infection following OP procedure. An incident of recurrent stenosis following the operation occurred in both groups. There was no postoperative morbidity or severe implications at 12 month follow-up in either group.
Conclusions:
Both OP and LP are safe and effective procedures for the treatment of ureteropelvic junction obstruction in the pediatric population. However, the shorter hospital stay and decreased cytokine response following LP indicates potential benefits over traditional invasive procedures.
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