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Laparoscopic versus open pyeloplasty for ureteropelvic junction obstruction in children: a systematic review and
Hong Mei1, Jiarui Pu, Chunlei Yang
1Department of Pediatric Surgery, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Insights
Laparoscopic pyeloplasty (LP) is a safe and effective minimally invasive treatment for ureteropelvic junction (UPJ) obstruction in children, offering shorter hospital stays. Open pyeloplasty (OP) has a shorter operative time but similar success and complication rates.
Area of Science:
- Pediatric Surgery
- Urology
- Minimally Invasive Surgery
Background:
- Ureteropelvic junction (UPJ) obstruction is a common cause of congenital hydronephrosis in children.
- Pyeloplasty is the gold standard surgical repair for UPJ obstruction.
- Advancements in minimally invasive techniques have led to the development of laparoscopic pyeloplasty (LP).
Purpose of the Study:
- To conduct a systematic review and meta-analysis comparing laparoscopic pyeloplasty (LP) with open pyeloplasty (OP) for pediatric UPJ obstruction.
- To evaluate operative time, hospital stay, complication rates, and success rates between LP and OP.
Main Methods:
- A comprehensive literature search was performed across major databases (Medline, Embase, Web of Science, Ovid, Cochrane) up to October 2010.
- Systematic review and meta-analysis of eligible studies, including one RCT, two prospective comparative studies, and six retrospective observational studies.
- Data extraction and quality assessment were performed independently by two reviewers.
Main Results:
- The analysis included 694 cases of LP and 7334 cases of OP.
- Open pyeloplasty (OP) demonstrated significantly reduced operative time and a higher stent placement rate compared to LP.
- Laparoscopic pyeloplasty (LP) was associated with a shorter duration of hospital stay, with no significant differences in complication or success rates between the two methods.
Conclusions:
- Laparoscopic pyeloplasty (LP) is a safe, effective, and minimally invasive option for pediatric UPJ obstruction, associated with shorter hospital stays and comparable outcomes to OP.
- While LP shows promise, further randomized controlled trials (RCTs) are needed to fully elucidate its long-term efficiencies due to potential publishing bias.
Purpose:
To comprehensively review the available evidences in the literature on the use of laparoscopic pyeloplasty (LP) vs open pyeloplasty (OP) for the repair of ureteropelvic junction (UPJ) obstruction in children.
Materials And Methods:
Published studies until the end of October 2010 were searched from Medline, Embase, Web of Science, Ovid, and Cochrane databases. The literature search, quality assessment, and data extraction were independently performed by two reviewers. A systematic review and meta-analysis were performed by using Review Manager 4.2.8 software.
Results:
Of 1403 studies, one randomized controlled trial (RCT), two prospective comparative studies, and six retrospective observational studies were eligible for inclusion criteria, comprising 694 cases of LP and 7334 cases of OP. The OP has significantly reduced operative time (weighted mean difference [WMD] = 59.00; 95% confidence interval [CI] = 41.15 to 76.85; P < 0.00001) and higher stent placement rate (odds ratio [OR] = 5.97; 95% CI=3.17 to 11.26; P<0.00001) compared with LP, whereas the duration of hospital stay was shorter in the LP group (WMD = -0.40; 95% CI = -0.77 to -0.03; P=0.03). No difference was observed between LP and OP regarding complications (OR = 0.78; 95% CI = 0.46 to 1.34; P = 0.37) or success rate (OR = 1.76; 95% CI = 0.71 to 4.36; P = 0.22).
Conclusions:
LP is a minimally invasive, safe, and effective therapy method for UPJ obstruction in children, with shorter hospital stay and excellent outcomes, and without additional risk of postoperative complications. Because of the publishing bias, a series of RCTs are necessary to explore the efficiencies of LP in the management of UPJ obstruction in children.
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